20261 870 LILY AVE
Building Permit Confirmed ❑
Not Required
CITY OF SAN JOSE I BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Datena-R-O'A )--I------- 1; k Permif No-----2U-21. j..............
The undersigned hereby makes application 4o 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' Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes this•a pplicaatio // - -
San'Jose City Business License # G�5 �'�L��Y
I certify that in the performance of the for which this permit is issued I shall not employ
any person in any manner so as 4o violate the workmen's compensation laws of California.
OWNER � 20"
ADDRESS 1712 C .4 Lot No.
USE OF BUILDING
280-3019-731 Signed . ..�'1.Clti%l!�/1.-- -=-=.........-- ----
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