12201 1150 Stafford drive
Building Permit Confirmed-[]
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date...l.--- '— /- ---------------------- 19.7✓ Permit No.............L..4��---------------
The undersigned hereb]makes wppl�a}ion to the Plumbing Inspector of }he City of San Jose
• for a permit to install plum bisTg fitfuras%n'dlor {iipes listed/on,the reverse side.
Exemption from requiremen4 for Sff'Celifornia {oc.Eonfre ctor'z License is hereby claimed
by undersigned: ` a}e o
es owner qV statement filed ElUndersigned attests that his State of CCalifornia Contractor's License #
is in full force and effect and properly authorizes th�� cation. /� / �
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 manner so as ss to violate thework.en's compensation laws of California.
OWNER ZI Aa,(1.f7 GfS�CLr/�4/
ADDRESS / Ol Lot No.
4
USE OF BUILDIN
280-30(?-73) Signed
1150 Stafford davis
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