16534 S31 November Diive
n Building Permit Confirmed
V`
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or. GAS PIPPING PERMIT
Date A-�s4.�-----.------------------ 197SPermit Not�---J �-------------
The undersigned hate yy a es application to #he'Plumbing Inspector of the City of San Jose
fora permit +o ins}all pplGm in sA /or #ed n he reverse side.
Exemption from rreq re ff o f iprrt aofe �ractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of y�s-s�'�liforni. Contractor's License 23 RSS 6 C-5-:1
is in full force and effect and properly aj7i app ii�rr��
San Jose City Business License �� 6 /si'.
I certify that in the performance of the work for which 4 is permit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER ROS W ELL
ADDRESS � 31 V-VEM A 2 � Lot No.
USE OF BUILDING
280-30(9-73) Signed ------- - ----- ----------1--a. ----------....
931 Nokembe1 Drive , c e. Pools r
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