17717 (2) 7750 OROGRANDE PLACE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date--- �-
-----'' -- -0 191C Permit No.------/--/�.
. .7/. //t
The undersigned he?by�rf srapplication o Iha Plum 6ipg Inspector of the City of San Jose
for a permit to install mbing�fr tine and or �p`eseliste9 8n the reverse side.
Exemption from requirX 1e or SIeof Cah(orni�a 04.ntractor's License is hereby claimed
by undersigned: as owner ❑ • statement filed ❑
Undersigned attests that his State of CBGfor ysa.Contre�rfor's License # f W 7
is in full force and affect and properly au}� ieaS�fOs aappd ion!
tfSan Jose City Business License
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner,sq as to violate tho workmen's co pens
�g afion laws of California.
OWNER 1(/1 (�y/�
ADDRESS -77-C-1) QAL, Lot,No.
USE OF BUILDING ���l ��
CJ1/L(4 �� CID., Sic.
280-30(9-731 i / , - Signed .._- ---
7750 OROGRANDE PLACE. , CENTRALSERVICE
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