71867 (2) 7575 Prospect
Building Permit Confirmed ❑
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING
J PERMIT
Date------------�� -02-I--.....L.....----- I qVI Permit No.------74 ..U--7----------------------
The undersigned hereby makes applicationjo the PlumbiSg Inspector of the/City of San Jose
fora permit to install plumbjn ��RQre} d/or��ipes Its o;I, �verse side.
Exemption from requirement for�State ofI'Cdlif6rni for Contractors License is hereby claimed
by undersigned: as owner ❑ statement file /� 4� / /
Undersigned attests that his State of California Contrador�icensa / / CO/
is in full foes and af{oc1 and properly�e� 31
thoriz .fhiiap� r
San Jose City Business License .# `'Y / J `E'
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_R,T-7.
- _
ADDRESS - /
USE OF BUILDING
FORM 280-30 IOM 3/67 gned
7573 Prospect Zupcic
FIXTURES FiXTURES MAIN DRAIN
Water Heaters Floor Drains Size Material
Water Closets Hoppers To I 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 ,b
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee
TOTAL TOTAL FEE Q
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines Outlets Size
Rough a _ Tested and Approved
Finish f Aq 7 ,g t. '7