16839 Plumbing/Gas Application 927 Rose Blossom Drive CJ /
J/ Building Permit Confirmed L�
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Da#e---',J-E—pr...... .0<------------- 19 �- Permif No../I/'-.Y.-?-f--.-----------------
The undersigned hereby m s epplice}ion to the Plumbin�fIn'}s�p�r of 1ha Ci}y of San Jose
for a permit {o install plumb' g n / a� �t erze side.
Exemption from require o ate ifornia for n}rec or's License is hereby claimed
by undersigned: as wnerX statement filed ❑
Undersigned attests that his State of California C s Ly��
is in full force and effect and properly authorizes thi p tion('/�
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 Aola}e the workmen's compensation laws of California.
OWNER 415WPY G` /QQ�i4s✓� dC=C
ADDRESS 922 60-5- � {�LUS421'7 'Z�.' Lot No.
USE OF BUILDING S 112E^^AGE
280-30(9-73) Signed - - --- y -. !1.------------
927 Rose Blossom Drive owner
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