6917 (2) 7425 Rollingdell Drive
7 Building Permit Confirmed ❑
/ Not Required —4�4—
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
_ /
Date.-------------------------
---- ...z�---------- 19��. Permit No........----------- ----------------------
The undersigned hereby kas application o Plumbi Ins�gd9r of the City of San Jose
for a permit to install pu n r a s fSf�n/�1t4erse side.
Exemption from require no ali or a or onf cfor s License is hereby claimed
by undersigned: as wner ❑ statement filed ❑1,YlZ3.7 C36
Undersigned attests that his State of Californ' Contractor's License #
is in full force and effect and properly authorises
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 compensation laws of California.
OWNER 'DUST /l , /F
ADDRESS 7 `f Z S 2 o e c avc Dc�cf_ 7V- Lot No.
USE OF BUILDING k6S
r
67
-----ti
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