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82727 (2) L655 S4r.=Surjn9vale Building Permit Confirmed ❑ Not Required CITY OF SAN JOSE BUILDING DEPARTMENT APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT Date _. .... ./j.....-----------.... 19L±. Permit No..-'----- �. iT.. ------- The un signed hereby sfiapplication to the Plumbing Inspector of the City of San Jose for a permit to install plu in xtur / li d tfy�erse side. Exemption from requ { o a is License is hereby claimed by undersigned: as wner ❑ statement filed ❑ / '' ' Undersigned attests that his Stale of Califo is Contractor's License #- —C-4 is in full force and effoct and properly author s hi / icati. oryr A� `, / San Jose City Business License # l��F�/�i'//b�— Y I certify that in 1h0 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 sacompensation laws of California. OWNER A v uSC" "/hu v1/ O P( ama �� k v y ADDRESS USE OF BUILDING A24 ef A Signed ------------ 280-30 se-ee ,/J r 1655 Sar-Stihhyvale /V"60 ego 'lmbin FIXTURES FIXTURES MAIN DRAIN Water Heaters / Floor Drains Size g Material C, Water Closets Hoppers Isr, To Septic Tank Bath Tubs Sand Traps RAIN WATER DRAINAGE Showers Urinals Size Material Lavatories /¢ Area Drains To Curb To Main Sewer KWM Sinks / Water Leaders WATER SYSTEM Dish Washers Trailer Space Size /4 WMaterial CO Waste Disposals Swim Pool FEES Wash Trays Indirect Wastes Fixture Fee Washing Machines Drywell Main Drain Fee Water Treat. Equip. Backflow Preventer Storm Drain Fee Sinks Survey Water Sys. Fee Dental Units Gas Piping Fee — Drinking Fountains Survey Permit Fee 2 TOTAL TOTAL FEE INSPECTOR'S REPORT HOUSE GAS PIPING Partial No. lines Outlets Size Rough Tested and Approved, Finish By .