76611 (2) 1655 Sar-Sunnyvale Rd
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS —PIIPING PERMIT
Date---V- ..1 .. . ............... 19�G3.. Pernni# No......... ./....G.6-1--1
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plu in f' PA a he reverse side.
Exemption from re i r r nlrac4or's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ T-�O-283
Undersigned attests that is State
of CE)
a iracfo s License $� -�`— 1 C' 3G
is in full force and effect and properly a"fhoris a;Pli ���
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 A ST/?uGTi ,gai CC) ,
ADDRESS /6 5-S— S SRRHToGA — R.b, SAN Fovi
USE OF BUILDING /-/C. 9-
FORM 280-30 IOM 1/68 s�2 RE
Signed . .G : 'T/ d........
1655 Sar-Sunnvvale Rd
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Material
Water Closets Hoppers To To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size
Material
Lavatories Area Drains To Curb To Main Sewer
Kitchen Sinks Water Leaders WATER SYSTEM
Dish Washers Trailer Space Size Material
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee /A p—v
_Washing Machines Drywell Main Drain Fee r�
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee
Dental Units
Gas Piping Fee 0
Drinking Fountains Survey
Permit Fee
TOTAL TOTAL FEE j
INSPECTOR'S R PORT HOUSE GAS PIPING
Partial No. Lines
Rou h !T`Outlets Z Size /j
g Tested and Approve
By 12,1 x
v