95928 (2) 50 9 ParK V111a cllcic
S Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPINGG PERMIT
Date----Afr'. ------- -------------- 19-.'/L.. Permit No............
g ---- --
for a r66Y makes
he
ahpermit
to i1nsfall,plumb`n'rR'fr4ss"�a"d/cr,�pipW!Iisted�on the ereversef side,City of San .lose
�eq a.+®�y epi�q- . r ii. cr ap
Exemption from requ vem n# for Mate of California fot Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ��
Undersigned attests that his State of Californi.Antra'ctor's'�Liconsee
is in full force and effect and properly authorizes tkid'applicatiian.�9 `
San Jose City Business License # L��
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 the workmen's compensation laws of California.
OWNER 4
ADDRESS �� ����o Lot Noy�9
USE OF BUILDING
JOE AM AL PLUMBING, INC.
280 30 Signed ..----------------------------------------------------------------------
905719 "
-----------...-----------------------------------9057 )
ark Villa Circle Amaal Plssmhin .,
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size " Material
Water Closets Hoppers To ' 1 To Se is Tank
Bath Tubs / Sand Traps RAIN WATER DRAINAGE
Showers / Urinals Size Material
Lavatories Area Drains To Curb To Main Sewer
Kitchen Sinks / Water Leaders WATER SYSTEM
Dish Washers [ Trailer Space Size /' Materia
Naste Disposals Swim Pool FEES q
Nash—Trays Indirect Wastes Fixture Fee /
Washing Machines Drywell Main Drain Fee .(f�
Wafer Treat. Equip. Backflow Preventer Storm Drain Fee
;inks Survey Water Sys. Fee /
)ental UniIs Gas Piping Fee
Drinking Fountains Survey
Permit Fee 2,QQ
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
'artial —/ y No. lines / Outlets 2 Size
lough G - 7 Tested and Approved ;fZ 7Z
finish ^'72- By