24137 (3) 1171 SO. STELLING ROAD
Building Permit Confirmed C?'�
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT,
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date C3 — 3 0 197PermiPNo. 2 y I 1
The undersigned hereby makes application"to,tte•PWmbing Inspector of the City of San
Jose for a permit to install Plumbing fixtures,aridlor pipes listed on the reverse side.
Exemption from requirement for State of California for Contractor's License is hereby
claimed by un rsigned:. M as�owner (K statement filed O' P
Undersign�ttests that his State of California Contractor's License N
is in full force and of ecGandlproperly authorizes'this application.
San Jose City Business License p / .0,/
I certify mat-inhe performa�ce.of the wor0o'r 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.
Job Address �� � I SD/ 4faini .f Qr� Lot No.
Owner 17, Srmnrl��S Tract No.
Permittee s M r
USE OF BUILDING Rr" Signed
280 401 n
1171 SO. STELLING ROAD OWNER
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