6930 (2) 7945 Fall Ct.
9 Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Dataz .. --..... ��Permit No......-----�.�-J�----------------
/The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
fore permit to insta�l'JJ,,,Jt��uffV i fur nd JJ99as Ji f.m on the reverse side.
. - Exemption fror�r6�67/e��errf d lfifar i or Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed)
Undersigned attests that his $ja.of Califo�nib gg//y�SScte Li e
is in full force and effect and pr Is duthoyfes� �.e5 ons —
$en Jose City Business License �—
I certify that in the performance of the work for which this permit is issued I shall not employ
any person inaany-manner so as to violafe.fhe workmen'sco(hpensation laws of California.
OWNfsR
ADDRE55\ � t—�l- I� Lot
USE OF � Iy
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