29961 1139 5h'�.��'0� nitYv�
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE / BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS-PIPING PERMIT
/. . �
Date--- --- �Q- i 19 ?'PermitkNo.. / /..
'99(:5;
The undersigned hereby rmakes application to the Plumbing Inspector of the City of San Jose
for a permit to install pluj'hbig.vf,lures nd{or pipasAVe�o�fh�reverse side.
Exemption from requirement eentYYfgf Istel.%f'Celifornie/for Contractor's License is hereby claimed
by undersigned: • as owner El statement filed
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes fhii�appIIIic'''afion. T
San Jose City Business License
I certify that in the performance of t�k (or whit fhis permit is issued I shell not employ
any person in anny/y y��a�nnper so as to violate the workmen's compensation laws of California.
OWNERIy'CL& 6
ADDRESS 3 Lot No.
USE OF BUILDING
Signe .. .. - -- -- �-------- ----21�
280-401n
1138 STAFFORD DRIVE of ACE
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