12763 7909 Belknap r
Building Permit Confirmed ❑
Not Required —I=1—
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPPING PERMIT
Date---------...... ---- --- --- --- - -- – -- / '-- ---- -` /-77- �---------
The under, es a+ion a ing�f the Ci+y of San Jose
for a permit to install plum ng fixtures end/or pipes lisfed on the reverse side.
Exemption from requir ent for State of California for Contractor's License is hereby claimed
by undersigned: es owner ❑ statement filed ❑ x•36
Undersigned alfa,}9 ha4 State of C rni C tr cfo 's a �{" 3
is in full force end e0f operly eu e i e is 11Qg/1 `
San Jose City B s Lic ,e
I certify that in the pe ormance of the work for which this permi is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER
� g (36 -1(,vAP DIZ Lot No.
ADDRESS 72
USE OF BUILDING tet)
280-30 (9-73) Signed.CC_�f..C...!L, ... - `-"--f. -----------------
7909
....._.4'.7909 Belknap ace
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