3562 901 Cottonwood G
Building Permit Confirmed 11�
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date..----------- --------------- I /------- Permit No.---......>�.5.�-.v----------------
The undersigned hereby mek a plica}ion t the Plumbing Inspector of the City of San Jose
for a permit to ins}all plumbin / paf'I d i reverse side.
Exemp}ion from req uiram C ri ac}or's License is hereby claimed
by undersigned: as wner.[]/ statement filed ❑
Undersigned
is
that
his St
of California Contractor's License #
is in full force and effect and properly a�Llro>r
Sen Jose Cify-Business License
I certify }hat in the performance ofof heork for which this pm
eri4 iz ssued I shall not employ
any parson in any manner so as to violate the workmen's compensation laws of California.
OWNER 1— Inj0A PICKEIL
J
ADDRESS 9()9() /�� L 07-1QNu000 D�z
USE OF BUILDINGG�2/t (n�� � �- {� /
480-30
Signed-----kllr ld0..----I �LG�2 o---------------.._.
901 Cottonwood Pi.ckell
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