79601 (2) 840 Kim St
Building Permit Confirmed ❑
Not Required E —
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date.. ----- .....----------_ 194P Permit No...7/....f?..�/---------..........
Date
hereby m s a p he.P bl for of the City of San Jose
for a permit to ins}el plum n y 9B(bfi averse side.
Exemption from requirement fo tate of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed O r./
Undersigned attests that his State of Ca' o p/_�����ntrac 6
is in full force and effect and properly auth as !frit app' a n.
San Jose City Business License # 9
1 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
ADDRESS
��9��t/
USE OF BUILDING `/S Z,�g�
..
200-30 10-60 Signed---
840 Kim Si A�e
FIXTURES FIXTURES MAIN DRAIN
Wo—terHeaters Floor Drains Size Material
Water Closets HoppersTo 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 Iswin, Pool FEES
Wash TraysIndirect Wastes Fixture.Fee p g'
Washing Machines Drywell - Main Drain Fee
Wafer Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks' Survey Wafer.Sys. Fee
Dental Units .. Gas Piping Fee
Drinking Fountains Survey
Permit Fee pD'
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
'We Lines Lines
Rough Outlets Size
n� Tested and Approved
Finish S n •� � By