24137 (4) 1171 SO STEL-LI RD
Building Permit,Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date- ---- ----.1..�:.LJ------------ 19�/O. Permit No..-----.�{-.1��'7-------`----
The u dersigned 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 alifornia for Contractor's License is hereby claimed
by,undersigned: as owner statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes this application.
San Jose City Business License #
I certify that in the performance of the work for whichthis permit is issued I shall not employ
any person in any manner so as to violate the wo men's compensation law of Cattfor 'a.
OWNER016
ADDRESS Lot No.
USE OF BUILDING
280-30 (9-73), . Signe --..... . . . ,(k
1171 _SO STELLING RD OWNER
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