14971 (2) 835 September ct
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date-------------------- 8 - - - 19-' fermi+ No. - -f /../.../__.. .........
The undersigned her makes plicetion to the Plumbing Inspector of the City of San Jose
for a permit to install u r nd fion the reverse side.
Exemption from re s a a I r Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of Cali n Contractor's License # --2:r �WLJ CJ
is in full force and effect and properly authoe kK�P
San Jose City Business License
I certify that in the performance of the work for w ich this permit is iss ed I shall not employ
any person in any manner so as to violla�te the workmen's compensation laws of California.
OWNER `ZG f (-e
ADDRESS
/
ADDRESS
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USE OF BUILDING-
280.30(9-73) Signed -- --------'-.....--�j - ---'-------,-- /
835 September et Apache �_
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