96646 (2) 8166 Park Villa Circle
l Building Permit Confirmed
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
GN 7 9G 6 YF
Date.------- - ------------------------ 19._L Permit No.-------------"--------.._---------------
The undersigned here�95R}t.jprc +' fb�lhe Plu ��9 fes, c+or of the City of San Jose
for a permit to ins{all p�[im i�fs�jf�y'i/rtOr6Faffd7b�r pipess�isfatl"'on a reverse side.
Exemption from requirement fQr State of'California for Contractor's License is hereby claimed
by undersigned: as o r Q ate �iled
Undersigned ai#es}s That his Slafta fforniaa p`s(-1e e # G ��
is in full force and effect and propefly asst or, f f epplic.f*
San Jose City Business License # L [JQ0 y
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 •iolafe Aorkmen's compensation laws of California.
OWNER e4L,, J/U�GS
ADDRESS ���� �'' K UAL LA �� Lot No.
USE OF BUILDING1 � _
28030
Signed ._ - �1r ------------, e
P14FvofS
8166 Park Villa Circle Lifetime Pools
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Material
Water Closets Hoppers To To Septic 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 Material
Waste Disposals Swim Pool 1yr+ FEES
Wash Trays' Indirect Wastes Fixture Fee .2 y,6-p
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. / Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee
Dental Units Gas Piping Fee �o
Drinking Founfoins Survey
Permit Fee
TOTAL TOTAL FEE (, , m
INSPECTOR'S REPORT HOUSE GAS PIP Ig
NG
Partial _7 7- N/ No. Lines Outlets Size
Rough - Tested and Approved
FnuA � By