17729 (3) rr. U_
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Dafe.._.....I.D_-17.. 197,.. Permit No----------J- I
The undersigned he eby mSikesjeppl�+iofl'ta theeWumbingalnspe for of the City of San Jose
for e permit to install plum�inV�,fiqture�a�ndlo�p�p`e'fliyf�`dt�en �}herversa side.
Exemption from requirement7for State of California for Contractor's License is hereby claimed
by undersigned: Or as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full fore and affect and properly a ho i:o"Nis apph efi�o�n/./� �
San Jose City Business License p#y � L�0 1 on. i4
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner "S to �iolafe the workmen's compensation laws of
California.
OWNER
ADDRESS 7 2 Q Lot No.
USE OF BUILDING '4�
n/J
Signed---._I� �LCe CU-� �-
280-30(9-731 -'----_---------....._------ ---.-..
7728. OBSIDIAN CT. CENTRAL SERVICE _
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