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78006 (2) 7450 Fallen Leaf Building Permit Confirmed ❑ Not Required Zl/ CITY OF SAN JOSE BUILDING DEPARTMENT APPLICATION FOR PLUMBING and/or GAS P—IIPING PERMIT Date----OctobeJr...ls.. 19..68 Permit No.--- ---71 ------ 0-6-e..:. The undersigned hereby makes application to the Plumbing In�s�actor of the City of San Jose for a permit to install plu 1 01} / pi r3494J ov kb�erse side. Exemption from req 1r m1ni a C mi for(eoon}}e�(ors License is hereby claimed by undersigned: s owner ❑ statement ailed ❑ 216217 Undersigned attests that his State of Calf rnia Contractor's License #is in full force and affect and properly autho z epplica}yen. n ' San Jose City Business License # f is I certify that in the performance of the work for which this permit is issued II shall any person in any manner so as to violate the workmen's compensation laws of California. OWNER A. H. Jackson ADDRESS 7450 Fallen Leaf Ln. USE OF BUILDING Residence _U__L_LIGAN Water Conditioning FORM 200.30 (REV. 3/6e1 10M Signed .. . .C_. ... ...of Los..... Gatos... .. ... 611 University Ave. 7450 Fallen Leaf Los Gatos, Calif. 95030 Culligan FIXTURES FIXTURES MAIN DRAIN 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 Washing Machines - Drywell Main Drain Fee Water Treat. Equip. .00 Backflow Preventer Storm Drain Fee Sinks Survey Water Sys. Fee 1.00 Dental Units Gas Piping Fee Drinking Fountains Survey Permit Fee 2 00 TOTAL 1.0 TOTAL FEE 4.00 INSPECTOR'S REPORT HOUSE GAS PIPING Partial No. Lines Outlets Size Rough Tested and Approved Finish ,h SIX /(Y4 By