12672 (2) 604 Phil ct. /
Building Permit Confirmed ❑
Not Required --e—
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING 7PERMIT
Date-------------------------------------------------" l19-2'1- Permit No.---------/.,�.-L
/,7--4.-2Z7:7::---------
The undersigned hereby ma e9 'pili on�fo}h�flu.d,'otvZ re.o%f the City of Sen Jose
fora permit to install lumbin r s, dL0 {(pg{�i((li�;f'ed 6�g//ihe reverse side.
Exemption from requirement for Stale of Cali ornia for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ ' Y1
2 .37
Undersigned attests that his State of California)Con actor's�Llcense #
is in full force and effect and properly au{horixas }his�aflcal ��
San Jose City Business License
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
ADDRESS 6� � 0H/L CT Lot No.
USE OF BUILDING CS
I
280-30 (9-73) SignedF--� - .:t�.<"�P- - --- ---
604 Phil ct ace
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