21101 (2) 7515 MOLTZEN DRIVE
Building Permit Confirmed 12--�
Not Required ❑
CITY OF SAN JOSEBUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
--------------`--- 197(¢. Permit No---------2112l----------------------
The
112L--------------------
The undersigned here s a is io the 6mg "for of the City of San Jose
for aperm i} fo install u ii r pi I' a reverse side.
Evamption from re ' emenf r State f i rm f r o actor's License is hereby claimed
by undersigned: s owner ❑ statement ffileedd—❑ /7/ J7
Undersigned attests that his State of Ca onfrac} s i/I— V
is in full force and of{ac} and properly eu}ho s pl' /
San Jose City Business License # 4 3
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 }he workmen's compensation laws of California.
OWNERC—
T4ncr Lot No. \ -z—
,§-48o ADDRESSUSE OF BUILDING
280-30(9-73) Signed --- h �r�
.Oy.-Jol�---.---
7515 MOLTZEN DRIVE CENTRAL SF.R%7TCF.
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