386941196 STAFFORD DR
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APP/L�TIOO/N FOR PLUMBING and/or
and/or GAS PIPING
(�PERMIT
Date-:/. -. .5 ....'............_._...... 19(..D... Perrni# No........- -....(_--------.------.
The ndersigned hereby makes applica}ion to the Plumbing Inspector of the City of San Jose
for a permit to install plumblh9 fixfu es end/or^pipes listopon the reverse side.
Exemption from req uiremg f orI ia}e•of�Celifornfe for Contractor's License is herebyclaimed
by undersigned: as owner ❑ state I '/���
y
Undersigned attests that his State of California Con actor's LjcQ
is in full force and effect and properly au oLizes this ap ;cationr�
San Jose City Business License # �7 ey /.7�'r
I certify that in the performance of the work for which this permit is issued I shell not employ
any person in arty mgnner so as to violate the workmen's compensation laws of California.
OWNER
ADDRESS
USE OF BUILDING
Signed
1196 STAFFORD DR
IR-WIM
280-401n
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