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69707 1450 Jam0§tWh Building Permit Confirmed Not Required ❑ CITY OF SAN JOSE BUILDING DEPARTMENT k� APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT ..................... vl7. Date.....---- -...---RvE------"�_.3---------- 1967.... Permit No........_970. The undersigned hereby m s applicatio i the Plun*.,ng in actor of the City of San Jose for a permit to install plumb' g ( r Ipe Is on c to side. Exemption from require o e ali o le ctor's License is hereby claimed by undersigned: as wner ❑ statement filed ❑ Undersigned attests that his Stat f. liform y/+r r' sf •�j�' �y� is in full force and effect and pro e rite R. /K San Jose City Business Licensep� 'y— %/C• 11 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 violate the workmen's compensation laws of California. OWNER p v o Rs df OR/ ADDRESS i�sO yg129e57--0 �e/ /J Pyuo USE OF BUILDING /f1a Po FORM ZOO'30 (REV. 3/fie) IOM Signed ----- ick.^'.X. -------------------- 1450 - ----1450 Jamestown Blue Haven Pool FIXTURES FIXTURES MAIN DRAIN Water Heaters / Floor Drains Size Material Water Closets Hoppers To I To Septic Tank Bath Tubs Sand Traps RAIN WATER DRAINAGE Showers Urinals Size Material Lavatories Area Drains To Curb To Main Sewer Kitchen Sinks Water Leaders WATER SYSTEM Dish WashersTrailer Space Size Material Waste Disposals Swim Pool FEES Wash Trays Indirect Wastes Fixture Fee j Washing Machines Drywell Main Drain Fee Water Treat. Equip. Backflow Preventer -Storm Drain Fee Sinks Survey Water Sys. Fee Dental Units Gas Piping Fee ,I, .y Drinking Fountains Survey Permit Fee i TOTAL / TOTAL FEE INSPECTOR'S REPORT HOUSE GAS PIPING Partial /�'/11--7 h' No. Lines Outlets Size Rough / Tested and Approved /0.,-7 Finish �� By