71868 (2) 7561 Prospect
• Building Permit Confirmed C,
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT/
Date-------------- b.-�---f�----------------. 19G•/-. Permit No.--Wo o �' ..........................
The undersigned hereby makes application to the Plumbing Insp ctor of the City of San Jose
for a permit to install plug big§�4ix ores dfar pipes #ed��flia r¢verse side.
Exemption from requireme/nf foraSta}e,of Californi foilr6onfrac}or's License is hereby claimed
by undersigned: •as owner ❑ statem¢nt
Undersigned attests that his State of California Contractor's Licens
is in full force and effect and properly, th ig
roperly,9a}hhig } �ppli tion.
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 co m ensation laws of California.
OWNER_7;F —,F I
ADDRESS 7 G
USE OF BUILDING
FORM 280-30 10M 3/67 5' ned..
r - -
-
7561 Prospect upcic
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 FEES
Wash Trays Indirect Wastes Fixture Fee
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Wafer Sys. Fee
Denfal Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee bell,Q Q
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines Outlets Size
Roughor 0—D Tested and Approved
Finish / Q ) By