25490 (2) 1130 SOUTH STELLING
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION/FOR PLUMBING and/or GAS PIPING PERMIT
Date._. . /.w---------------------- 19..�fl�//Permi# No..-52.7..� ----------
The undersigned hereby makes
aap�pppllf�iication to the Plumbing Inspector of the City of San Jose
for a permit to install plumR� N�N� b Mil' a }ha reverse side.
Exemption from require f r niractor's License is hereby claimed
by undersigned: as caner ❑ statement filed ❑ 3
Undersigned attests that his State of California C r r se
is in full force and effect and properly aufhoriz s this io
San Jose City Business License # ,— / !K-�
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 violl.tte the workmen's compensation laws of California.
OWNER
T//✓ ( '��o4f/%J�✓/7
ADDRESS 1130 -'ldS,�e//TG Lot No.
USE OF BUILDING W-/h'07 ee"'
280-30 (9-73) Signed .... ... �iL --- .......-----
1130 SOUTH STELLING ACEI''"F ,b�, a/7eJW. X 97 /Of
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