79310 (2) 842 Kim
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING nand/or GAS PIPING PERMIT
Date.. � i.`._.. ��...------------------- IS S". Permit No.--------7 -----
The undersigned hereby p f' ctor of the City of San Jose
for a permit to install plu �' s ,2r"�pip63 R C iCirre reverse side.
Exemption from requirement fo State of California for Confractor's License is hereby claimed
by undersigned: as owner Elstate a (i ed ❑
Undersigned attests that his State of Calif n' Sitracto
is in full force and effect and properly aufhoriz s this application.
San Jose City Business License # �L
I certify that in the performance of the wor for which this permit is issued I shall not employ
any person in any mann so as to violate the workmen's compensation laws of California.
OWNER 157
ADDRESS
USE OF BUILDING
FORM 280-30 10M 1/68
Signed
g
842 Kim
Ace �� .
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Material
Water Closets Hoppers To To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size Material
Lavatories Area Drains I 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 O
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 o C el
TOTAL TOTAL FEE 0'
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines Outlets Size
Rough - Tested and Approved
Finish
911 �� A7 By i