22034 (2) 7525 TIP TOE LANE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date JV ---------------------- I4 Permit No.---------a' --.Q J - ----------
The undersigned hereby makes ap 'ca}ion #o }he PI mbi Inspector of City of Sen Jose
for a permit to install plumbing fixt es s n e r d
Exemption from requirement fo S ali rme or C str c or nse is h a r a b y cIaimod
by undersigned: as owner statement filed
Undersigned attests that his State of California Conirac+ License #
is in full force and effect and properly au#horkes Jhi�plic io
San Jose City Business License # Q,
I certify that in the performance of the work for which this permit is issued 1 shell not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER
ADDRESS ��� �/ �(L� / Lot No.
USE OF BUILDING (' Y I —
280-30(9-13) Signed- '- .- ..!/C -- ---------------
7525 TIP TOE LANE /
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