77944 1641 Jamestown
Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date_.�a,-------- ...� 19.6.X.ryPermit No.--------.7---7-y..�-
The undersigned hereby ekes applicati n 1 the Plurpb'n I�n��QQctor of the City of San Jose
for a permit to install PI
u s pi tgQ'yF r`eZrse side.
Exemption from raqui at rn or Co ratter's License is hereby claimed
by undersigned: as owner ❑ statement filed 0
Undersigned attests that his Slat ( fornia s i e is in full force and effect and proper :es i
San Jose City Business License i— 7
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any Inamler so as to violate the workmen's compensation laws of California.
OWNER A (1
ADDRESS
USE OF BUILDING
FORM 280-30 10M 1/68 Signed........
^\es --" --- t
1641 Jamestown
FIXTURES FIXTURES MAIN DRAIN
Water Heaters ✓ Floor Drains Size Material
Water Closets Hoppers To I To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size FMaterial
Lavatories Area Drains To Curb I To Main Sewer
Kitchen Sinks Water Leaders WATER SYSTEM
Dish Washers Trailer Space Size Material
Waste Disposals Iswim Pool ✓ FEES
Wash Trays Indirect Wastes Fixture Fee d�
Washing , achines Drywell Main Drain Fee
Water Treat. Equip. Backflow Preventer ✓ Storm Drain Fee
Sinks Survey Water Sys. Fee
Dental Units Gas Piping Fee r36
Drinking Fountains Survey
Permit Fee �. r
TOTAL ITOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
-artial O '79i n ni- ✓v - No. Lines)-j( . Outlets Size`
tough Tested and Approved �,g'
'finish W
l ! 7 "775 (//f nOi✓�l ey (� /