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 .