80498 (2) 1180 Elmsford C�
J Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date... . . _Z .............._- l94-/,- Perrnit No.-----. G:..U............--
Tha nd ersigned hereb makes application to the Plu Bing Inspector of the City of San Jose
for a permit to install p m n is} d/ I e d on the reverse side.
Exemption from re u' r f t f or Contractor's License is hereby claimed'
by undersigned: as owner❑ sfafement filed ❑ �S—S3 �j
Undersigned attests that his St'f sjv.alifor ' o }r of ry is se
is in full force and effect and pro ply Mulhorix c fl�/nJ Y� d
San Jose City Business License #
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.
OWNER
ADDRESS //��`��'�����Fd� I� LOT—�Q
USE OF BUILDING I& �r�— Z�N T
xeo-ao ro-ae
Signed .. ...r.- ..-_ .
1180 Elmdford T & F
FIXTURES FIXTURES MAIN DRAIN
Wafer Heaters Floor Drains Size Material.
Water Closets Hoppers To To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size Material
Lavatories Area Drains I To Main Sewer
Kitchen Sinks Water Leaders WATER SYSTEM
Dish Washers Trailer Space Size Material
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee
Washing Machines Drywell - Main-Drain Fee
WaferTreaf. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee s
TOTAL TOTAL FEE
INSPECTOR' REP HOUSE GAS PIPING
Partial -� No. Lines
Rough / Ouflels Size �
Finish _ Tested and Ap ro d
By