87984 (2) 1107 Derbyshire Drive G
Building Permit Confirmed ❑
Not Required B_
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS (PI/NSG PERMIT
Date-------------------------- ....... ---- 1970.. Permit No . .. f-....L.. --J....-------
The undersigned here, is tl P pector of the City of San Jose
for a permit to install or es i o o ha reran- side.
Exemption from req?.rament or Slate of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his StateN C iforni Cont c} 'cenTa #' 2 3 7
is in full force and effect and proper ] o ix i 6 c Cs
San Jose City Business License TT��Y(Y!//
I certify that in the performance of the work for wrich this,p rmit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER FrcNrc-- Rr .4
ADDRESS _( (6-7 �-zn Ay aux Z)/2 Lot No.
USE OF BUILDING4V /J�
280-30 Aug. 69 Signed-dte- -C±L�G- ......
1107 Derbvshire Drive /'/ Ace Plumbinq
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Material
Water Closets Hoppers To I 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 Size Material
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee 00
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 PNo. L
4GASPIPIN4G
TOTALINSPECTORSREPORTPartial e
Rough 7�7 p roved
Finish