38664 1141 HOLLY HEAD LANE fi vyeX/1T•n(
—""Buifding Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date...�/GU•. ...._.-----..._.... Perrnif No.......3.q14}W. ,..................
The undersigned hereby es p r do }o a Plumbing In for of the City of San Jose
for a permit to
'n tell
plum in is Kc ••erre side.
Exemption from requirement ( $talc Cali o ni r on cfor s License is hereby claimed
by undersigned: as owner statement filed
Undersigned attests that his $}ata rm n ct L.
is in full force and effect and properly e; Ca3N
San Jose City Business License
t ,
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER C-t "
ADDRESS )/0)/ Lot No.
USE OF BUILDING // ' /
Signed ... ...t.../{�y/1a-2,$) ? �,�'�C l-.
I l A l TTnT.T.V NF.AT) TAMP. HIDE PLBG/.280-401n
FIXTURES N0. FEE MAIN DRAIN
Water Heaters Size Material
Water Closets To Fee
Bath Tubs RAIN WATER DRAINAGE
Showers Size Material
Lavatories To Fee
Kitchen Sinks WATER SYSTEM
Diah W s ier Size Material
Waste Disposals Water Fixture Fee
Wash Trays HOUSE GAS PIPING
Washing Machines No. Lines Outlets
Water Treat. Equip. Size Fee
Sinks FEES
Dental Units . Fixture Fees c�
DrinkingFountains Main Drain Fees
Floor Drains Storm Drain Fees
Hoppers Water Sys. Fee
Sand Traps Gas Piping Fee
Urinals -'- Survey
Area Drains Permit Fee -�
Water Leaders TOTAL FEE
Trailer Space INSPECTOR'S REPORT
Swim Pool Go Piping
Indirect Wastes Approved
Dr well B
Backflow Preventer Partial
Survey Approved
B
Rough
TOTAL Approved
B
Fi i.sl
Approve I
B