89510 1566 Jamestown Dr (/^
-I Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PICPyING PERMIT
Date..------------......// J................. 19._� Permit No------Z S/ 0
------------"------`-------
Theundersigned hereby ap lication o the Plumbing Inspect r of the City of San Jose
for a permit to install plu in s /kn t} re rse side.
Esempfion from requir an r to ali r ors License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests fhat his �to f California Confracfor's License #a..J?9�_—
is in full force and effect and prop�tthoriz 's pl' /
San Jose City Business Lice ��+G
I certify that in the performance of the work for which }his permit is issued I shall not employ
any person in any the
so as to violate the workmen's compensation laws of California.
OWNER 1-24S7 w
ADDRESS i.S �4 fi4Motfawsv Die-
Lot No.
USE OF BUILDING PF 5
/� J
280-30 Signed-z:5?.te---iY j
1 S66 .Jamestown Dr Ace Plbe
FIXTURES FIXTURES MAIN DRAIN
Wafer Heaters Floor Drains Size Material
Wafer 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 / p'.)
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Wafer Sys. Fee
)ental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee 0 J
TOTAL TOTAL FEE 1� o
INSPECTOR'S REPORT HOUSE GAS PIPING
rartia) No. Lines Outlets Size
tough ,�� n_ Tested and Approved
•mrsa / G / 7i-/ By