24125 (2) 1055 TUSCANY PL 5
Tr�c� 58y�/
Building Permit Confirmed
Not Required ❑`
CITY OF SAN JOSE BUILDING DEPARTMENT . .
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Da#e-------------------------------�.-.J7-'D---- 19.7 Permit No.._:._ -- ..
The undersigned hereby'makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumb i i u sd �pe' iSfv n reverse side.
Exemption from require a a' ni r ctor's License is hereby-claimed
by undersigned: as ner ❑ stafement f{led
Undersigned attests that his State of California ontractor's License #
is in full force and effect and properlyauthorizes f e ation. �
San Jose City Business License #
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner so as to violate the who,kmen's compensation laws of California.
OWNER ON erOSA 1�Oi/// °5
��
ADDRESS S / Lot No. S
USE OF BUILDING d"fSlq�yC� /
280-30(9-13) ( Signed..CYQ.lw E'fy--(7 ------------------...-
11055,TUSCANY PL CROWLEY
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