86068 (2) 759.2 Holland rry
Building Permit Confirmed ❑
C Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING/ PE/R�MQIT
Date---------`-�1...'C--a-..---------------------- 19�.�- Permit No.---------------.. C1.Q.V.ff.......-..
The undersigned Horeb m kes ep Iic ion to the Plumbing In actor of the City of San Jose
for a permit to install p� pi s id. o evorse side.
Exemption from req a n r $t o ' o o o cfor s License is hereby claimed
by undersigned: of as owner ❑ statement file 3 ss�
Undersigned attests that his Stat or
ornm.,yr�tra or e l
is in full force and effect and propeFly/des
Sen Jose City Business License
1 certify that in the performance of the work for whit this permit is issued I shall not employ
any person in any r, er so as tothe workmen's compensation laws of California.
OWNER
ADDRESS Z
USE OF BUILDING---�/ 7
- -
FORM 280-30 10M 2,975 D r,'OAD
REDWo0u Cl , ,,,, CALIF. 365-0114
7592 Hn77anelprry Alwin Plumbin4
FIXTURES MLeaders
URES MAIN DRAIN
WaterlHeaters ESize
Material
Water'Closets To Septic Tank
Bath Tubs RAIN WATER DRAINAGE
Showers Material
Lavatories urb To Main Sewer
Kitchen Sinks ers WATER SYSTEM
Dish Washers Trailer Space Size I Material
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee
Washing Machines Drywell Main Drain Fee
Water Treat. Equip, Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee
TOTAL Do TOTAL FEE 3 c7
INSPECTOR'S REPORT HOUSE GAS PIPING
sarhal No. Lines Outlets Size
Cough y Tested and Approved
imsh By