8457 (2) 908 Rose Blossom Dr
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GASPIPINGPERMIT
Date...... .�._C's.\..... ----------- 19-7V Permit No....... --l--�YL�---7--------------------
The undersigned herb ekes application to the Plumbing Inspector of the City of San Jose
for a permit to instal l pl bi i e ip reverse side.
Exemption from requir at r i f rector's License is hereby claimed
by undersigned: owner ❑ statement filed ❑ ,J
Undersigned attests that his State of Ca' ornia Contractor's License #
is in full force and effect and properly auth it y�R
San Jose City Business License # �)�
I certify that in the performance of {hework 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 t O
ADDRESS gDc4 o5<21 SSO Lot No.
USE OF BUILDING
Signed
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908 Rose Blossom Dr T&F
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