21101 (2) 7483 MOLTZEN DRIVE
(_aI Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING 'and/or GAS PIPING PERMIT
�G
Date------5 ------ 19.7 ' Permit No.------------- ----------
The undersigned undersigned h"n ,
ti to iPl m n Spector of the City of San Jose
for e permit }o inslallor s} o he reverse sido.
Exemption from raa of all ornie {or on}recior's License is hereby claimed
by undersigned: r ❑ sta#ement filed El
Undersigned attests that his State of Cali ni4a��J.�++n}ractor License #'
is in full force and effect and properly aufho se`j6c�applic
San Jose City Business License # y (('' y
1 certify that in the performance of the work for which this permit is issued 1 shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER 7261-'24L-
ADDRESS
6ti'2LLADDRESS 7 /L(UL%�.r �% D� Lot No. Q
USE OF BUILDING�45S '
280-30(8-73) Signed----- r i1-------'5.f—�..1 '�------------------
7483 MOLTZEN DRIVE CENTRAL SERVICE
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