30605 (2) 1167 STAFFORD DRIVE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Dafe ernrif No.--30--6."`-_vS7--
The undersigned hereby m kes ep$ication 4%%thadPlumbing Inspector of the City of San Jose
for a permit to install plum bit g4fi fu im r2pwp�s ®ad� Rhe reverse side.
Exemption from requirement foryLtate of California for Contractor's License is hereby claimed
by undersigned: as Yowner ❑ atetement filed
Undersigned attests that his State of Ca omia ontre�f"I.6vo.4 #
is in full force and effect and properly authorizes this a f'
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
ADDRESA - —
USE OF BUILDING
Signe AS ter.... . �r�.. .:.1---------------- --
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1167 STAFFORD DRIVE ANTHONY POOLS
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