13185 (2)' 849 Kim St. q
1 Building Permit Confirmed ❑
Not Required 9 .
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING ]PERMIT
Date-------------------- z — - 2 . 197i . Permit No.----------/ 3 ----------------------
The
----- -The undersigned he y makes application to the PlVmbing I ecfor of the City of San Jose
for a permit to instal
PI
g x �glyor s is - reverse side.
Exemption from 1 or a li(o nia fo on racto,'s License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ 7�/ 2 - �.3 i
Undersigned attests that his State of California Contractor's License # L Iv
is in full force and effect and pro erl#' �(�l�ih HBs this a lic io
San Jose City Business License LK .
I certify that in the performance of the work for which this permit is is ued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER DoyFkseiK& l�J•
ADDRESS '?y ? k/ /'I S I ' Lot No.
USE OF- BUILDING /Z f
280-30(9-73) Signed .aeu...%
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