68958 (2) Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date'----------------Apg11---25................ 1967... Permit No.---------- .d'y ..a'.. ...
The undersigned herebymakes c # P um binspec}or of the City of San Jose
for a permit to ins#a u or fe n he reverso side.
Exemption from e e if rni niractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of Calif nia Contrac#ors License # 23428_
is in full force and affect and properly author } pylic
San Jose City Business License # -
Jj_}
I certify that in the #performance of the work for whic is permit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER DRUARY E. COOK SAF "ST-E� _��.
1150 DELL AVE.
ADDRESS w 7557 iifG RD CT CAMPBELL—CAUF.r
USE OF BUILDING ' T10ITSg101D 379-5050
Signed ._ .. .. t ....�.t�...1--------r��.._..
FORM 20030 BEV, 3�G01 IOM 9
7557 Lockford Softmaster Perez
FIXTURES FIXTUR[S MAIN DRAIN
Wafer Heaters Floor Drains Size Material
Wafer Closets Hoppers To To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size Material
Lavatories Area Drains To Curb To Main Sewer
Kitchen SinksWater Leaders WATER SYSTEM
Dish Washers MDrywelIMain
Size Material
Waste Disposals FEES
Wash Trays tes' Fixture Fee 00
Washing Machines Main Drain Fee
Wafer Treat. Equip. venterStorm Drain FeeSinks Wafer Sys. Fee' pp
Dental UnitsGas Piping FeeDrinking FountainsSurvey
Permit Fee _v-p
TOTAL A TOTAL FEE o D
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines Outlets Size
Rough „ _ Tested and Approved
Finish L'7 By
IV /7' s /tis io7 7 �.p