94064 (2) `. 862 East Estated Drive
Building Permit Confirmed
Not Required '❑
CITY OF SAN JOSE BUILDING DEPARTMENT .
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date---..... -.'..-3--------------------------------. 19..7-. Permit No.------- l'.q O-`-y----------------
The undersigned hereb makes application to 0. Plu g Inspector of the City of San Jose
for a permit to ins}r p m �i ' e on the reverse side.
Exemption from re r e a o ie or Contractor's License is hereby claimed
.. by undersigned: as owner A statement filed ❑
Undersigned attests that his to of C liforni c tr r an e
is in full force and effect and p
San Jose City Business LicecArd
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER � �N�
ADDRESS 5�2. E. CS7Ares /��, Lot No.
USE OF BUILDING CAR ' PC RT^ (SAM C-Z�� CLIN6
280.30 Signed---(M 1 4F�5-------- R SE/v--------- ...
862 East Estates Drive Hansen
FIXTURESFIXTURES MAIN DRAIN
s.
Water Heaters Floor Drains Size. . Material
Water Closets Hoppers To To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size Material
Lavatories Area Drains To Curb To Main Sewer
Kitchen Sinks Water Leaders WATER SYSTEM
Dish Washers Trailer Space Size Material
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee Z rrd
Washing Machines Drywall . Main Drain Fee
Water Treat. Equip. Backflow Preventer Sform'Drain Fee —
Sinks a RIA I Survey Water Sys. Fee
Dental Units Gas';Piping Fee
Drinking Fountains
Survey-
--Fe--Permit Fee - a-v
TOTAL TOTAL FEE S. G
INSPECTOR'S REPORT HOUSE GAS PIPING Xf
Parti°) No. Lines' Outlets Z Size /it
Rough Tested and Approved
F�msh By