95928 (2) 8077 Park Villa Circle
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING
�j PERMIT
Date.itS`c-C— {'"—.....------...-----. 19.�/. Permit Nod............L..`S.J,-Z'�-----------
The undersigned hereby ma�s�a�plican }o th Plumbin Inspector o4 the City of Sen Jose
for a permit to install ITnb�g/f�fr�:dryoRpip5�)stm o�the reverse side.
Exemption fromkfegmreme//pt'for S e1e ofZI;f9ri1a for Contractor's License is Is claimed
by undersigned: O as owner ❑ statement filed
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authoriiesjsfS1s a p1'cation.
San Jose City Business License #' ((� r�;*/, r "O Q./ �1[ -
I certify that in the performance of—ork for which this permit 44"ued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER
ADDRESS; 1L0'/� �L��J(/�� Lot No.
USE OF BUILDINGo�
O�Ar L PLUMBING, INC.
280 30 Sig ed -----------_....------------------------------------------------"
X 77—Y"ark Villa Circle Amaral
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Material,/�i_iJ�.
Wafer Closets Hoppers T u��,� To Sep /c Tank
Bath Tubs / Sand Traps RAIN WATER DRAINAGE
ill wers / Urinals Size Material
.avatories 'L Area Drains To Curb To Main Sewer
Utchen Sinks Water Leaders WATER SYSTEM
)fish Washers Trailer Space Size /' Maferia�;,
Neste Disposals Swim Pool FEES
ash Trays Indirect Wastes Fixture Fee
Noshing Machines Drywall Main Drain Fee Z.
Water Treat. Equip. Backflow Prevenfer Storm Drain Fee
iinks Survey Water Sys. Fee pa
)ental Units Gas Piping Fee ,ZZ
)rinking Fountains Survey
Permit Fee
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
'ortiol 1 -7- -7 /�jJ�Tlati' No. Lines / Outlets ,2_ Size
Tested and Approved 7- Z
finish —�— Z /1M By nue