8079 (2) 1195 Gardenside �y
/LJ Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PI IIjNG PERMIT
Date---t---f------------------------------------ 19V9.- Permit No.------- --v....7
X.-----'-----
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbing fixtures and/or pipes listed on the reverse side.
Exemption from requirement for State of California for Contractor's License is hereby claimed.
by undersigned: as owner statement filed l �. O ,C
Undersigned attests that his State of California Contractor's License
is in full force and effect and properly a�uth�orixG/s this application.
San Jose City Business License #LT—L�
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 /IIA FCAlteI@
ADDRESS J / q l (-, a R oeyy Sr P LN Lot No.
USE OF BUILDING NUrlr
Signed---�7�+�y..-� -----------------------
28030 l 0
1195 Gardenside Flaver
FIXTURES NO. FEE MAIN DRAIN
Nater Heaters Size 5-" Material (gS''Tic
Nater Closets To Fee b
Bath Tubs RAIN WATER DRAINAGE
Showers Size Material
Lavatories - To Fee
Kitchen Sinks WATER SYSTEM
)ish W s er Size Material
Vaste Disposals Water Fixture Fee
Vash Trays HOUSE GASP IPING
Vashing Machines No. Lines Outlets
Vater Treat. Equip. Size Fee
Sinks FEES
5ental Units Fixture Fees ,00
)rinking Fountains Main Drain Fees a. Io
=Ioor Drains Storm Drain Fees
coppers Water S s. Fee
Sand Traps Gas Piping Fee
Urinals Surve
Area Drains Permit Fee U6
Vater Leaders TOTAL FEE 00
frailer Space INSPECTOR'S RE ORT
iwim Pool Gas Piping
ndirect Wastes Approved
>r well B
lackflow Preventer Partial
urvey Approved
do By
Rough
TOTAL A proved
4
Fi ish
Approved (y —
B