89660 A825 pklinger Rd
O
Building Confirmed y
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS _PIPING PERMIT
Date------------------------------------------------- 19..--5.. Permit No-----U--/--�-�-0---------
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbing fixtures and/or pipes listed on the reverse side.
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ D� rf.67i
Undersigned attests that his State of California Contractor's License
is in full force and effect and properly authorizes this application. / � ��((
San Jose City Business License $k (5
q /
1 certify that in the performance of the work for which this permit is issued Ibshall not employ
any person in any
nee, so as to •iole}e the/qorkmen'l compensantion laws of'Celifornie. ) _
OWNER dJ /J/
ADDRESS Sopa S lee�/�"ei� _14.61 -e.Lot No.
USE OF BUILDING
Si ned ..-- -------- ----------
5825
----- - • -----------------
28030 (J -. ../../.. _ .
5825 Bollinl2er Rd vl J. D. Plumbing
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains y Size Material
Water Closets 3 Hoppers To I To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers —Urinals —/ Size Material
Lavatories Z Area Drains - To Curb To Main Sewer
Kitchen Sinks Water Leaders WATER SYSTEM
is WashersTrailer Space .Size Material
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee
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 I Survey
Permit Fee
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines Outlets Size
Rough �L Z 7 47 44&1 4. Tested and Approved
Fmuh BY