91381 (2) 7395 Rainbow Drive
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Dafe.---------- .---/-....------------------------- 19..2Y Permi+ No.------------471,.. /.......---
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 0 _
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly e�''JJ}hori.7 this application.
San Jose City Business License #' 17,11-0
`/— /'�5.,2
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any ner so as to viol Pe
the workmen's compensation laws of California.
OWNER /e4
ADDRESS S Lot No.
USE OF BUILDING
280 30 ( Signed.'.. . - I - ..
7395 Rainbow Drive Purdy Plumbin�
FIXTURES FIXTURES MAIN DRAIN
Wafer Heaters / Floor Drains SizeC " Material „(
Wafer 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 I Material
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee a
Washing Machines Drywell Main Drain Fee -�
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee 0 v
Dental Units Gas Piping Fee a �Q
Drinking Fountains Survey
Permit Fee O O
TOTAL TOTAL FEE .�
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial -/,�- 7/ /l No. Lines Outlets Siz
Rougher Tested and Approved
Finish - '_rf By _�-