80118Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPI G PERMIT
Date ----3" -l.'--- --- ...... - 19------- Permit No- -------_...7'..0XA?......
The undersigned hereles application to the Plymbing�lrrtt��pac}or of {he City of San Jose
for a permit to ins{all p m fi are n i s i dd the reverse side.
Exemption from ra irt��n�rtor( f� CSorsfrac{or's Li<ens3,is hereby claimed
by undersigned: ��as owner ❑ statement filed I[}
Undersigned attests {hat his State I' aFnia Con ' ns /�
is in full force and effect and properly uy u nz�4his app{
San Jose City Business License
I certify that in the performance of the work for which this permit is issued I shell not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER��' WIT
ADDRESS
USE OF
280.30 10-60
ver C6111ri- SUNKIST Pools
FIXTURES FIXTURES MAIN DRAIN
Water Heaters -/Floor Drains Size Material
Water Closets Hoppers To To Septic Tank
Both 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 Washers
Trailer Space
Size Material
Waste Disposals
Swim PoolPT-
/ FEES
Wash Trays
Indirect Wastes
Fixture Fee
Washing Machines
Drywell
Main Drain Fee
Water Treat. Equip.
Backflow Preventer
Storm Drain Fee
Sinks
Survey
Water Sys. Fee
5ental Units
Gas Piping Fee O
Drinking Fountains
Survey
Permit Fee
TOTAL
TOTAL FEE
INSPECTOR'S REPORT
OUSE GAS PIPING
rartial
tough
ef 42
LNo.Lines
Outlets Size /
Ap rove
finish