41428 (2) 1283 STAFFORD DRIVE
Building Permit Confirmed ❑�
Not Required f7�`
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Dat - 2 5 ---- ...... 17. Permit No. -- --t
f' -........
The undersigned hereby makes application 4o the Plumbing Inspector of the City of San Jose
for a permit to install pjum jinn fi+}�re�j �or pipe> on the reverse side.
Exemption from raqusremen�or Safe o4C&ornia for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed C 6 JO
Undersigned attests that his Stela of CSllfornie'Conlectorjs/LieensgW
is in full force and effect and properly eu} orifi ss his gppliselion��
San Jose City Business License #
I certify that in the erformance of hh;work for which this permit is issued I shall not employ
any person in any mann r so as 4o viola}e the workmen's compensation laws of California.
OWNER
ADDRESS Lot No.
USE OF BUILDING
r
Signed'--.-/?,� -------------------
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G SC � lit/-("pO/A "�6-o 8o-401n
1203 STAFFORD DRIV E A. 3. .TFRMTTF
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