12766 (2) YSb7 reaca Blossom arive
Building Permit Confirmed ❑
Not Required u
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date------------------------/-- -......... 19?� Permit No...--------/` -------
The undersigned hereby ek snap Iicafi_ 0'
the PI ,bin Inspector of the City of San Jose
for a permit }o install plum �ffS} ��'� apt' •`` sto6��ifi reverse side.
Exemption from requ uemen for State of alifornf5 for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ G� Z 3 7 C 3
Undersigned attests that his State of California C�pn}ractor's License # O
is in full force and effect and properly authoriz 11t is a'ppl�cfi!' 6 U
San Jose City Business License #— 96: t /fY.�.(/•// �' ,
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 violate the workmen's compensation laws of California.
OWNER YA/-714.TI f �r
ADDRESS ?S6 ? PC—,ICH OLassan D2 Lot No.
USE OF BUILDING 2CS
280-30 (9-73) Signed arw.Q...PE1- e ------
7567 Peach Blossom drive ace
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