41214 (2) X925 BOY�T�TNGER ROAn
Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBINGand/or GAS PIPING/PERMIT
Date-----,;-5..7.... ..I6...------------ 19?L.q Permit No.............--..... - vY-------.
The wrclertigned 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 ❑
Undersigned attests that his State of California Contractor's License # 3
is in full force and effect and properly authorizes this application.
San Jose City Business License #��—O U
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
O W N ER L 7�f/E/sRN CY�Cv/L /-�
ADDRESS ��5 j4CL N�j-� Ze /� Lot No�e�LG-!5- Ze /� Lot No.
USE OF BUILDING �� ° C
.GAY" '------- ------'......
280-401n
5825, AOLLINGER, ROAD, CHURCH-OWNER
c Wpm E -ic DC o ST O vv� o 0 0 0 � 7cr T W f E _--_•
A 9 0 �' y 0 N N N 0 0 0 0
A E n
o- f 1 2 �C
N N N 0 1
p O C N N
-------------
N
Z
O
T
m
m
W D W 9 Co 9 W N 0 E
9 V 9 O O O k N O N O N 0 M
ma o N O E
�c T > E 3
D
S S O r 2 0 N O O m R O Z
m A D
m
m N O � A. o: N _ A D
m — 1
a w N N i i z Z