69400 (2) 4951 Fol&stblie^•
Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING
�/PERMIT
Date.....JUN.7.-..I967 -------------
The
- 19...... Permit No..- - t0..../..--1..U-
The undersigned �Q',e� a sat' # e/fM�bing Inspector of the City of San Jose
for a permit to ins}a plu / ing re ar�deY isf ad on the reverse side.
Exemption from requn7ment for S+ le of California for Contractor's License is hereby claimed
by undersigned: as ow A� 1 } filed l G
Undersigned attests that his State f CeliforniS.0 nitf4iv LLice nYe {' ❑ v�"O
is in full force and effect and propery aufhori; his application.
San Jose City Business License # �'��{—�Q
I certify that in the performance of the work for which flis permit is issued 1 shall not employ
any person in any mepnerso a to violate the workmen's compensation laws of California.
OWNER—�'
ADDRESS
USE OF BUILDING
FORM 200-30 (REV. Signed w.., _ _ '
9951 Folkstone F&W
FIXTURES FIXTURES MAIN DRAIN
Water Heaters / Floor Drains Size Material �!
Water Closets 3 Hoppers To I To Septic Tank
Bath Tubs / Sand Traps RAIN WATER DRAINAGE
Showers - / Urinals Size /" Material may.
Lavatories Area Drains To Curb I 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 L3, ay
Washing Machines / Drywell Main Drain Fee
Water Treat. Equip. Backflow Preventer Storm Drain Fee -ap
Sinks Survey Water Sys. Fee c, d
Dental Units Gas Piping Fee ,r0
Drinking Fountains Survey
Permit Fee oZ U
TOTALTOTAL FEE . S'
INSPECTOR'S REPORT, HOUSE GAS PIPING
Partial No. Lines Outlets Size
Rough 4/,-7 Tested and Approved C '/j,f G9
Finish / -7fj;;%rG (A16jf�[G By