23360 r / 1040 TUSCANY PLACE
Building Permit Confirme�
PI'" ,,,,� Nof Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBINGand/or GAS PIPING PERMIT
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--.- - - 19.76/Permi+ No....� .... 1-.. c!
The undersigned hereby es application to the Plumbing Inspector of the City of'Sen Jose
fore permit }o
install
plu p d er¢varse side.
Esamp}ion from requir en 1 ctor's+License is hereby'claimed
by undersigned:' r s�owner ❑ slafame'n},fBed:0%66 998
Undersigned a}tests'.fha! 'his':Stete'of California ntrac}or's License,#
is in full forceend�eff1.ect.'and properly authorizes !h• a}ion,Q
San(Josa'CiI.ty^Business.Lieenso,$): / //�///c/ s'-//✓/ l — .
I�ca�tify;f hal;in:}he perfoimenca.of the work for which this permit is issued I shall not employ.
n imenyma noerrso as to'yiolafe the workmen's compensation laws of California.
any perso
OWNER / �Ot/OeYOSA 110114
ADDRESS /D7`D 7L1,5cA1vv Rife Lo+ No. Z•
USE OF BUILDING , I eStdeNG e / v
280.30(9-73) Signed CYe . e7 v--- r ------------
1040 ,TUSCANY PLACE CROWLEY
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