94968 (2) 6166 Park Villa Circle
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION pFOR PLUMBING and/or GAS PIPING PERMIT
Date..------`- /.Q'—�d - -------... 19! .. Permit No...� __ .Z-..L. - ------------
` �''� ? �/
The undersigned hero � 4Y'd�plieation to the Plumbing'Inspector of the City of San Jose _
for a permit to install plumbilIg futures end/or pipes listed on the reverse side.
Exemption from requirement for Stgfe ,o�.,,ffy aCalifornia for Contractor's License is hereby claimed
by undersigned: as owner l51� `qx Wdetem ot-filed ❑
Undersigned attests that his Stale of California Contractors L se
is in full force and effect and properly authori �th' lication.
San Jose City Business License # •J�
I certify that*in the performance of the work for which this permit is issued I shall riot employ
any person inan _ anner so as to violate the workmen's compensation laws of California.
OWNER' �
ADDRESS ��6 Lot No.
USE-OF BUILDING
MARAL PLU ING,. 1
NQ
28030. Signe�QE_A------------------------------------------------------....
8166 Park Villa Circl.a Amp,-al
FIXTURES FIXTURES MAIN DRAIN
SJKC-tchenSinks
ters Floor Drains Size " Material ,�;
sets Hoppers - ToS/u/bLc1 eol To Sept Tank
Sand Traps RAIN WATER DRAINAGE
Urinals Size _ Material
�' Area Drains To Curb To Main Sewer
nks Water Leaders WATER SYSTEM
hers Trailer Space Size l f Materia
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee
Washing Machines Drywell Main Drain Fee .00
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Wafer Sys. Fee • 00
Dental Units cJ i/q Gas Piping Fee
Drinking Fountains Survey
p '✓� Permit Fee 'G
11,...r;�1xCiM" �/" TOTAL TOTAL FEE
w. INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines Outlets Size
Rough' Z `�
72 y�a„?�_' Tested and, Approved _-13` L
Finish /_1 •7? ��`1YClivrt r By 2f
jl wl 4fbf,t. Layb'23'7t 7i>Anr