83901 6087 Bollinger Road
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE "/ BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT .
Date---------------- -.___/_� ---._.. 19..C- Permit No.-------------d.--�../ 1-
,...6. -----
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 E3ry
Undersigned attests that his State of California Contractor's License # �-:3 2 26
is in full force and effect and properly authorizes this applite}ion. p
I- San Jose City Business License # '— �rl8o
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 workmen's compensation laws of California.
OWNER /10&/VC-R C 6-
ADDRESS
ADDRESS (, C A7 6LLL- IVC" /
USE OF BUILDING /`nf Ff
2e0-30 to-ee Signed .CC.✓j ._-----------�.L�..L.L�- —
6087 Bollinger Road
Ace PLugfbing �
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Material
Water Closets Hoppers - To 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 SpaceSize Material
Waste Disposals ME
FEES
Wash Trays Fixture Fee ,OU
Washing Machines Main Drain Fee
Wafer Treat. Equip. r Storm Drain FeeSinks Water Sys. FeeDental Units Gas Piping FeeDrinking FountainsSurveyPermit Fee U p
TOTAL FEE OD
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial
No. Lines Outlets Size
Rough Tested and Approved '
Finish By