100478 (2) ']417Itainbor�pµ/i✓$�u� �y� -
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT.
APPLICATION FOR PLUMBING and/or GAS PIP�I(N/rG PERMIT
� Al/.... � -
..... 19- ----. Permit No.----=- IJGL--
The undersigned hereb k is io ill u/n ng for of the City of San Jose
for a permit to install pl b f' r pi s 17 o revorse side.
Exemption from requ r t tat Ca i rni r orfractor's License is hereby claimed
by undersigned: owner ❑ statement filed ❑
Undersigned attests that his State of Calif i,s.vContract rs Lic ysej
is in full force and effect and properly authori a ysss appli / ,
San Jose City Business License # / �V
I certify that in the performance of the work for which this permit is issued I thall,not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER (5�2 d7.ff2n . C6ivsT Co
ADDRESS
USE OF BUILDING R 11
._Signe .--- �.9.?' - .. .. - V`
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1
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FIXTURES FIXTURES MAIN DRAIN
Wafer Heaters Floor Drains Size Material
Wafer Closets Hoppers To' To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size •'
Material Cjk7
Lavatories Area Drains To Curb To Main Sewer
Kitchen Sinks Wafer Leaders WATER SYSTEM
Dish Washers Trailer Space Size I Material
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. Backflow Preventer StormDrain Fee
Sinks. Survey Wafer Sys. Fee -
Dental Unit, Gas Piping Fee
Drinking Fountains Survey
Permit Fee
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. lines Outlets Size
Rough Tested and Approved
Finish By