10772 7876 Belknap q
/ Building Permit Confirmed [a /
Not Required ♦r]/
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date.-"... - "xs
it. o. - -- L-- --------------------
The uncle ign s p i or of }he Cify of San Jose
forapermit nst p u ing fix re aed on the reverse side.
Exemption from requi ment for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ p3 Z-,3.7 C2 �1�e
Undersig d attests that his State of California Contractor's License # O
is in full for nd t and properly thor' s i pli io �a,t,,t
San Jo ness
License
I cer}i of in performa o ike work r which }hi er i issued I shall not employ
eny perso in any annex so as to violate the workmen's compea ation laws of California.
OWNER kI LI
ADDRESS 7b'7(, e�kNA"p Da. Lot No.
USE OF BUILDING ES
280.30 Signed
� Imo// ✓//
7876 Belknap ace
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