68366 (4) 1590 Jamesftwn /v
Building Permit Confirmed ❑
Not Required Ril
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date------------------------------- — .�- 19.L.7 Permit No......1 /c% (U..SG----------
The undersigned her y makes application to the Plumbin Inspector of the City of San Jose
for a permit i ins}ell, /or list the reverse side.
Exemption from re or a ali o on+rector's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his S of��tt,,C,, alifornia Contractor's License
is in full force and effect and•pro rl�orix ' w p li on.d
San Jose City Business License /�
I certify that in the performance of'tho work for hick }his permit is issued I shall not employ
any person in any manner o as to violate the workmen's compensation laws of California.
OWNERA
ADDRESS I,�57Q
USE OF BUILDING
PonM 2.,.3O (REV. 3/66) IOM Signed "� "-••• - --
1590 Jamestown Serv-all
FIXTURES FIXTURES MAIN DRAIN
Wafer Heaters Floor Drains SizeMaterial
Water Closets Hoppers To I 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 It Q—
Washing Machines Drywell Main Drain Fee
Water Treat. Equip.1 Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee00
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines Outlets Size
Rough Tested and Approved
Finish gy