42162 7512 f3EATi�ERta00D DRIVE
Building Permit Confirmed
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPINGf PERMIT
Date 4/1 1 -................. 19........ Permit No.....---f--- _. ...L_�� --.---- --
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 a/
Undersigned attests that his State of California Confracfor's License #
is in full force and effect and properly``au,thorizes this^a�li 1'
San Jose City Business License # Y—?���
1 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 BrocE /L/OEL
ADDRESS JI �,Z ��� ?r/��721tJ00n �2 Lot No.
USE OF BUILDING Poo 11
Signed.... _ ll�/..." . .. . --- .-
tOR� 3 aQ ST,co
28 -�+Oln
Iris AF.ATPP.PWOOT) TlRTVT. _ RTORN CNST.CO.
FIXTURES NO. FEE MAIN DRAIN
Water Heaters Size .Material
Water Closets To Fee
Bath Tubs RAIN WATER DRAINAGE
Showers Size - Material
Lavatories To Fee
Kitchen Sinks WATER SYSTEM
D' Washer Size Material
Waste Disposals Water Fixture Fee
Wash Trays HOUSE GAS PIPING
Washing MachinesNRK is e s
Water Treat. Equip. Size
Sinks FEES
Dental Units Fixture Fees
Drinking Fountains Main Drain Fees
Floor Drains Storm Drain Fees
Hoppers Water Sys. Fee
Sand Traps Gas Piping Fee
Urinals Survey
Area Drains Permit Fee
Water Leaders TOTAL FEE
Trailer Space TSFECTO 'S REPORT
Swim Pool ,/ Ga_s Pi i
Indirect Wastes/ Approved
Dr well B
Bockflo Preventer Partial
Survey/ Approved F• 7-
By v
Rough
TOTAL Approved . 7f
V-h`iov —
by A 9411,t i t
t_' c• .'Br finish
Approved
8