69707 (2) 1450 Jam0§tWh
Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT k�
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
.....................
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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