94772 (2) 8086 Park Villa Circle
Building Permit Confirmed 9
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING/ and/or GASPIPINGP�EjRMIT
Date..---------/G..-.1e------------------ 19 --7/Permit No. .. .1..�-7.. -�-1 ----------
The undersigned hereby makes epplicatS'onppto k?aPlumhiag Inspector of the City of San Jose
for a permit to install plumFiing f�furei add/or plpeylistedJ on6tlio/reverse side.
Jfor S}ate of°Cehfornia for,Contrac}or's License is hereby claimed
Exemption from req.ir&7
by undersigned: L/ ' as owner ❑ statement filed E] ��
Undersigned attests that his State of Californiv Con}rac}or's License #'
is in full force and effect and properly au}hori�: i ��Ice}i�on��/,f
San Jose City Business License $� //
I certify that in the performance of the work for which this permit is issued I shell not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER
ADDRESS J��f� Q /_� Lot No. �9
USE OF BUILDING
28030 Signed ---- . .RA1...P.LUMB1NQ_,..A N—C
Af��� l�
F . Ir v; T T a c; rr1 a Amaral
FIXTURES - FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Maferial-
Wafer Closets c-,�L Hoppers To To Sep
N Wc Tank
Bath Tubs Sand Traps RAIATER DRAINAGE
Showers / Urinals Size Material
Lavatories , Area Drains To Curb To Main Sewer
Kitchen Sinks Water Leaders WATER SYSTEM
Dish Washers Trailer Space Size /" Material
Waste Disposals .(, [. Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee
Washing Machines DrywelI Main Drain Fee
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee
dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
raAial / - No. Lines Ouflets Size
tough — 3- 2 rL Tested and Approved
finish 7) - �,3". 7 y ./�j'//f- 7'/ Yr/ BY c-TPiI'_S.U•ClG