41191 (2) $01 MYYY,EIi AVENUE 16i�
Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLI ATIO FOR PLUMBING and/or GAS PIPING PERMIT
.J q
Date-- --��.. ........._._._.................. 19� Permit No.-----......y�l/-.�.......--------
T a under gned hereby makes application to the Plumbing Inspector of the City of Sen Jose
for a permit to install plumbing fixtures and/or ' s listed on the reverso side.
Exemption from re uirement for State of Calif rnie or Contractor cense is claimed
by undersigned: as ow er ❑ fa}em n fi d /
d ig ests that rs o alifornia ont'a r' Lice a (O
i in f f of an p po orixes }hi pplication.
ose�tysines License # -O' �{ b
I c ify that in th performance of the work for which this permit is issued I shall not employ
any pers n in any me ner so as to violate the workmen's compensation laws of California.
OWNER
ADDRESS ej Lot No.
USE OF BUILDING
Signed- -. ..yTw•. �t.. ... �, --,il ....-
280-401n
801 MILLER AVENUE FOOTHILL PLBG.
D
n XX
N !1 R N N C N ti ^ N N Il + A
m S
r N N m
N
Z
O
` w T
AT m
rl
W D W D WD co > TH G'1FN 3 T �!' Z Fin 1v� � v+
a a a a
a a a m C O O p O K H O m N p H p H
D
m 0T N D °. T H O K F Z
�' ►� c m '^ CI � �
mD D
� p D T � -m TN m 3m
r m m T m >n
y ;-mu,
m p m Z
m " m m
m