31180 (2) 8146 PARK VILLA
Building Permit Confirmed ❑
f Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Dafe-----October 10 19. 7 Permit No------3.1.�.L
............... ........
The undersigned herebl,rti9�bWeppl!tibnL'To the Ptumbi'dg`nspe'�lcfor of the City of San Jose
for a permit to install plumbing0ffkt4e's and r piposilisfebon }fa/reversa side.
Exemption from requirement/or State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑, statement filed E]Undersigned attests that his 5}eia of CelifbA.Con/ra'cfor'vs l:i nser 228671
is in full force and effect and properly aut iia�This a�pli[slioI 46006'!' Zo
San Jose City Business License #
1 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 F. Paulsen
ADDRESS 8146 Park Villa Lof No.
USE OF BUILDING resid�£nce
----------------
280 30
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8146 PARK VILLA CULLIGAN
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