23596 1104 ELMSFORD
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBI_N and/or GAS PIPING PERMIT
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Da#e A --.d� ------'------ 19---1`{. Permit No...3��...-...------------------------
The 4,1,"eigned h¢reby�m ak i a 'on-ts, + PI„urri� Inspector of the City of San Jose
for a perm t to install plyaib" p' t n the reverse side.
Exemption from requ men} or S}a}e o a ifornie for Confrecfor'z License is hereby claimed
by undersigned:
as owner statement filed 7
Undersigned attests that his State of CA
fiia Co c rs e=
is in full force and affect and properly au rj+}is p a '2'
San Jose City Business License #
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in anymannerso as to viola}¢�thJh workmen's compensation laws of California.
OWNER 1) fi,,a,
ADDRESS ))If Lo+ No.
USE OF BUILDING
280-30 (9-73) Signed -
1104 ELMSFORD ACE
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