26389 (2) Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date-.- ..................................... .._- 19 --- Permit No.------ lGz. G.-- ---------
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 ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes this application.
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 !Teem so_ es to viylp}e flke workJpen's compensation laws of California.
OWNER 'TI I tfWIII 11 t��^Jyj'r /IL Vmn(L F)
� ss �NYIMA/I I�U.Xll - SCanm� . Lot No.
ADDRESS USE OF BUILDING Q-IJ'f��AD�D
Signed -- ------MM..1-.- ....�- ----- -------------------------------_-
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