21100 (2) 54�A' KTNdgam'Y PLACE
- Building Permit Confirmed [2�1.
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date.----------- -4 (o �/ (�
------...------------ 19�----- Permit No.-----....--- -' ----------------'----"----
The undersigned hereb m g�fgfha�F rG' g 3p4j1or of the
City of San Jose
for a permit to install pl sd(' pjp9(li (b✓roversa side.
Exemption from raquiremeni r State o California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of Ce is nfraclor n
is in full force and effect and properly auth rix s epplic o
San Jose City Business License # (a 5 (�
I 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.
ie
OWNER T2sn) ELL
4oT-
c5'4$o ADDRESS -74'9$. 1"6 Lot No.S—
USE OF BUILDING fi�s
280-30(9-73) Signed----L ot."-."[,C�-r/1,-m-------
7998 KINGSBURY PLACE CENTRAL SERVICE
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