33143 1113 Stafford
Y,PVT ��//
y ro/s1 Building Permit Confirmed
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPINGPERMIT
J � `3
Date..........� D-- ...._.. 197Permi# No.. � . - .....
...-
The
undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plu'rrblh rfi 4uras end/or ip s'lisl cl the reverse side.
Exemption from req Iramen/ or State oHCalifordia for-Contractor's License is hereby claimed
by undersigned: �as owner ❑ statement filed
Undersigned attests that his Slela of Californi_p}�ontFaclorll.Ly9nsa �zs•.��jy1}y/_L�
is in full force and effect and properly eUfhoJi.es thfs{pppGce .4n
San Jose City Business License # d-9 Q//4 3
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 rrass��to violate the workmen's compensation laws of California.
!
OWNER 14rX ELLF 77f}-
ADDRESS ///3 -1,'-7LfQRD Lot No.
USE OF BUILDING Rt fJ f2 n/�
Signed .... .. 7 Z\.........
280-401n
1113 Stafford A.B. Termite
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