335747475 bt YrA' F'AikC2�J
qued Confirmed ONtRe
CITY OF SAN JOSE J r1 j— CBUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Dafe...�. .... ..- -------- ---- 19iv.-. Permit No. ----.............."---
The undersigned he a I' o og Inspec}or of the City of San Jose
for a permit to install I d r on the reverse side.
Exemption from req f for 5 ate o4 Celi ornie for Conlrecfor'z License is hereby claimed :
by undersigned: as owner ❑ statement filed
Undersigned attests that his Stat orn1a CggqJJJ!!lyyyacj�r'�J�jceryfe
is in full force end affect and grope y e }hi�pl�a�jly/J/
San Jose Ci} Business License s _
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 (!) I('/�l7 i76/2J
ADDRESS ' 1/9 Lot No.
USE OF -BUILDING
14
Signed ... .. - - --- ------ ---- uU
28o -401n
74 7 5 DE LAFARGE ACE
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