263971030 NOVEMBER DR
Building Permit Confirmed ❑
Not Required ❑
CITY OF .SAN JOSE / BUILDING DEPARTMENT
APPLICATIO
N
FOR PLUMBING and/or GAS PIPING PERMIT
Date ----- /_y{4�....�1.......----- ------------ . i.-g?2 Permit No. ------ ---------
The undersigned her y makes application io fe Plumbing Insp a}or of the City of Sen Jose
for a permit fo install n i{ We 1. a /lij*.d n1fhr,everso side.
Exemption' from�gp"��l f�fa'fe 'of Caili f r Cov etor's License is hereby claimed
by undersigned. 7'es owner ❑ statement filed ❑
Undersigned attests that his Sate of Calijornia Contractor's License #/-
is in full force and affect enicense erly eu} es Nis npplicaiibn.h. /�'—v'
San.Jose City
Business License #
I certify that in the performance of the work For which }his permit 4 issued I shalll shall not employ
any person in any nnp%nor so aj to violate the workmen's compensation laws of California.
OWNER
ADDRESS
Lot
USE OF BUILDING. U
X70
Signed ...�; 14 "in ..............
?\ j 280-,401n
1030 NOVEMBER DR"."`-
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