4050 (2) 1141 Kentwood /
Building Permit Confirmed )]'
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date------------- ------------------ 19..73. Permit No.-------------..L....
The undersigned hereby makes Ij' as i lu q, ns r of }ha City of San Jose
fora permit to
install plumbing fiv��pQ 6 �i�d� erse side.
'Exemption from requirement for Stafe f California or ontracfor's License is hereby claimed
by undersigned: as owner ❑ statement filed��r�.�
Undersigned attests that his State rl of hor eractor' 'fjsrll .(�S�Q�L
rs in full force and effect and properly authoriseslica}' r��(/ (iT/x-
San Jose City Business License # 113=07180061F
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any me9ner so as }o viola
OWNER /J�( te the workmen's compensation laws of California.
ADDRESS //�/ .� � 11rLot No. �S
USE OF BUILDING 1-1F /
280.30 1 Signed. .... .
- ---- -.rf:-•-'-"--..---
NJunse-
Ol
1,141 Kentwood Sunset
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