279281105 Rollingd'e11 Court
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE -BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date --��G.._ --..19.-- Permit No.��
...
The undersigned by makes. ap . at', to the Plu bin Ins r of the City of Sen Jose
for a permit to ins p ias ip is arse side.
Exemption fro qui a i rm f r rt ors License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that is State of CaIRArnia Contractor's License # eaI.0nn
?9SR
is in full force and affect and properly au fho :a epplicefi / /
San Jose City Businoss License #�
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I certify that in the performance of the work for which -this permit is issue I skall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER 0,',k V-, IV_ K
ADDRESS
USE OF BUILDING
Lot No.
Signed*- d>4t -----------------------
V.) 8o -401n
1105 Rollingdell Court - Vallev Water
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