82248 (2) 7533 BoLLinger Rd.
1 Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING------------------ CPEERMIT
Date--------------Jn1 --1' ----. ----------- 196!9-- -
Permit No.--- --Afo-4 .......
The und¢rsignedy reb m e o t up46igp/mspactor of the City of San Jose
for a permit to instal • ores or e o ¢ reverse side.
Exemption from requirement for Stale of California for Contractor's License is hereby claimed
by.undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of CalVprnia Contractor's License # 234281_
is in full force and effect and•properly autho : i appl' on/}� y/ '
'San Jose City Business License # " / ^
I certify that in the performance of the work or which tis permit is isTueJ I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER DONALD LEASUAE
ADDRESS —7533JMLLIWAir
USE OF BUILDING HOUSEHOLD •
FORM 280-30 IOM 1/68 � K-r
Signed.'-rg �!:..--- - .........
-
7533 BoLLinger Rd. Bohnet
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Material
Water Closets Hoppers. to To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size Material
Lavatories Area Drains To Curb To Main Sewer
Kitchen Sinks Water Leaders WATER SYSTEM
Dish Washers Trailer Space siz—ej Material
Waste Disposals "' Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee GO
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. / Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains _ Survey
Permit Fee ;vo
TOTAL TOTAL FEE eo
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines Outlets Size
Rough - Tested and Approved
Finish — 2.Z—(
By