21395 1110 SCOTLAND DR
Building Permit Confirmed
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
�j`-- 7 �..�'
Date 5 --
- ^ + '" ----------- 19./.6 Permi+ No.-----------02/�- .... -/. ------------
The undersigned hereby ekes li anon to the Plumbing I s ecior of the City of San Jose
for a permit to install plumbing u / s e e reverse side.
Exemption from requirement or t o if f Co ctor's License is hereby claimed
by undersigned: as own r ❑ statement filed ❑
Undersigned attests that his State of California asf�or's License # :35''/93
is in full force and effect and properly authorizes hi,/ p,}tea} " 6—?1C
' San Jose City Business License # ��/
I certify that in the performance of the work for which this permit is issued I 6all not employ
any person in any manner so as to �;ollaate the workmen's compensation laws of California.
�
OWNER 1� 5 Nn k T�g
ADDRESS � lIs �C CJ� Lo+ No.
USE OF BUILDING
280-30(9-73) Signed ---. --- .-----------
GI >�•So fl
1110 SCOTLAND DR 1./9/L/t 7L ARIA✓�
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