27853 (2) 1166 9TrV=NG
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
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Date...:/ - 2Q..._...--... - ....- 19.7E) Permit No... 0 -----------
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbing fixtures and/or pipes listed on the reverse side.
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License # s�3ye.
is in full force and effect and properly authorizes this application.
San Jose City Business License # tf-",:x — 4::) O if 7 6
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any�maanner so as to violate the workmen's compensation laws of California.
OWNER/7 11&IXL . C 46:A5S.
ADDRESS GZ 1,!;: a S T/c L L/n�G Lot No.
USE OF BUILDING t&u R c N
Signed)`.i"r I"'&C..C-C�'2.1:• rG.✓wt.,�/WP--.•i'�`�
1\ 280-.401n
1160 STELLING FRANK CIARI PLUMBING INC.
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