82051 20655 Cleo Ave. q
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date-- ...... ------------------------------- 191-F. Permit No-------------------OpZo- /-----
The undersigned h y makes lic io t Plymbing spec+or of +he City of Sen Jose
for a permit 4o insta pl g + pi s li d } e reverse side.
Exemption from r for St of o { re cfor's License is hereby claimed
by undersigned: es owner ❑ statement filed El
Undersigned attests that his State of California Contractor's License # Z 56870
is in full force and efiac+ a pro%��I.', auth fixes +hi agplic)/}'I n. r
San Jose City Business is
I certify that in }hap orm a of work for w ich '�DD rmi is issued I shall not employ
any person in any manner so as to violate the workmen's compeFsa}ion laws California.
OWNER ��` NeGL i $ V �5-jgf L
ADDRESS 53 Cleo Atl e
USE OF BUILDING
FORM 280-30 IOM 1/68 Signed .. ... ------ -----------------
20655 Cleo Ave.
FIXTURES FIXTURES MAIN DRAIN
Water Healers Floor-Drains Size rr Material
Water Closets Hoppers To /�,��. To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals. Size Material
Lavatories Area Drains To Curb To Main Sewer
Kitchen Sinks Wafer 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
Water Treat. Equip. Backflow Preventer Storm Drain Fee 7
Sinks Survey Water Sys. Fee
Dental Units 017 Gas Piping Fee
Drinking Fountains ,( Survey Z au
Permit Fee Z .�
TOTAL TOTAL FEE o
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial _ No. Lines Outlets - Size
Rough Tested and Approved
Finish — By