6184 (2) 7385 Rainbow
Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION
?FOR PLUMBING and/or GAS/PIPING PERMIT
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Dat -- ----- --------------- 19-;�3Permit No.-------Sll// ------------------
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbing fixtures and/or pipes listed on the reverse side.
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly aufhorixes this application.
/ '
San Jose City Business License # `�!<1 —xjt /? 5?
1 certify +hat 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 &CV ST /yC 711c//
ADDRESS 7 3 FS ��'A�✓ �j 04i i7�2 Lot No.
USE OF BUILDING
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