74071 870 Lily Ave ^
C I�1 Building Permit Confirmed ❑
Not Required —tfr—
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION
11 FOR PLUMBI//NpGr and/or GAS PIPING PERMIT
Date-`--' - 12
................................ 140{)..- Permit No.- L /J y------------------
-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 El nOdy
Undersigned attests that his State of California Contractor's License # 7
is in full force and affect and properly authorizes this appl'cation. ,_
San Jose City Business License # —�U�5 4
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 a }o violate the workmen's compensation laws of California.
OWNER
ADDRESS
USE OF BUILDING_ 396 Perrymount & Corner of Steri ntre,
San Jose, California 95125
FORM 2ee-30 IoM Use Signed ------------------- ------------247=8107.-----------------------
870
---- -870 Lily Ave Ace
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Material
Water Closets Hoppers To To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size
Material
Lavatories Area Drains j To Main Sewer
Kitchen Sinks Water Leaders WATER SYSTEM
Dish Washers Trailer Space Size Material
Waste Disposals Zry
FEES
Wash Trays es Fixture Fee
Washing Machines Main Drain Fee ,
Wafer Treat. Equip. enter Storm Drain Fee
Sinks WaferSys. Fee
Dental Units Gas Piping Fee
Drinking Fountains SurveyPermit Fee
TOTAL FEE Q
INSPECTOR'S REPORT HOUSE GAS PIPING
PO�1OI No. Lines Outlets Size
Rough Tested and Approved
By