17919 7476 Bollinger Road
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date / w........................ 192 Permit No. ----------------------- "
The undersigned hereby e s p �/f b' I specfor of the City of San Jose
for a permit fo install plum� Y' s he reverse side.
Exemption from requirement for fete of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed Z -
Undersigned attests that his State of Californ' nt actor License
is in full force and affect and properly authorises h' lice Y
San Jose City Business License #
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any mannor so 'as to violatetheworkmen's compensation laws of California.
OWNER
ADDRESS 6 v/61��` '-'/C 06V r . Lot No.
USE OF BUILDING
280-30(9-73) Signed ------------- -------- ---- ------------ --- -------------- .....
7476 Bollinger Road Leo Cruz Plbg.
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