5269 1151 Stafford Drive /
Building Permit Confirmed []'
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION OR PLUMBING'and/or GAS PIPING PERMIT
Date---- /�---/'------------- 19------.. Permit No.------5,2 G-9------------...----
The undersigned herebylmays7appliica 'on tVhe.Plumbing, Inspector of the City of San Jose
for a permit To install pl�bVg99�fi^x�ur�`� ddor s ishan the reverse side.
Exemption from requirement for Sfa}e of Cali ornie {or Contra ctor's License is hereby claimed
by undersigned: as owner ❑ s#afement filed ❑
Undersigned attests that his State of Celi{orvia Contractor's License #
is in full force and effect and properly authorizes Ilii{applic�afyio/ryry�j� /�
San Jose City Business License #� ,rC��"/o/����"� `S
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
ADDRESS ��_� �� �r d�U Lot No.
USE OF BUILDING
280.30 Signed .. ��(%,. -- ------ -- ------- --- ---....
1151 Stafford T&F
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