14531 (2)7650 Shadow Hill In
CITY OF SAN JOSE
Building Permit Confirmed ❑
Not Required ❑
BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING? PERMIT
Date ----`-1""'X --- ----........_._-------- 19.7�Permit No. -----� (e:A' --/-----"--------
The undersigned hereby make li m nS ee r the City of San Jose
fora permit to install plumbing r iste o flside.
Exemption from requirement for Stat of California or Contrac}or's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of California ontractor's License #
is in full force and effect and properly authorizes thi etion. �/f���--
San Jose City Business License �{' 4.S—.(1 /) ;WA ri (/
1 certify that in the performance of thwork �r which this permit is issued -rshall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER A41/111 G7 7Z�5AC,- )4>7`
ADDRESS 7657
s%� �OG�.� Y�J// th Lot No. 7,?
USE OF BUILDING /P—/
280-30 (9-73) Signed. - r / ------------------------
?650 Shadow hill In C/ apehe
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