5346 1127 Hollyhead bane
Building Permit Confirmed ❑
Not Required --0—
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date- --------------------- 197:3. Permit No.....-------- �- c-----------
The unde,signed horeby*s�owO
the Plumbing Inspector of the Cityof San Jose
for a permit to install ur / f the reverse side.
Exemption from r rI' . o n#rector's License is hereby claimed
by undersigned: statement filed El-2—r-1
Undersigned attests than his State o4 fo a Con#r30r sy
is in full force and effect and properly e �i sis ap�s �dr(/(/
San Jose City Business License # G1'�'x'3 y/
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 !IAL 01 4/h,
ADDRESS //Z 7 goz,z- a Z- Al Lot No.
USE OF BUILDING .S
zeoao Signed . .. r- 7_ `.. ✓.,. ?�..�0��....
IIP r7 TTnIIvhPAd Lane V %Ace
FIXTURES N0. FEE MAIN DRAIN
Water Heaters /•oo Size Material
Water Closets To Fee
Bath Tubs RAIN WATER DRAINAGE
Showers Size Material
Lavatories I To I Fee
Kitchen Sinks WATER SYSTEM
Diah Washer Size Material
Neste Disposals Water Fixture Fee
Nash Trays HOUSE GASP IPING
Noshin Machines No. Lines Outlets
Nater Treat. Equip. Size IFee
Sinks FEES
Dental Units Fixture Fees /. 00
Drinking Fountains Main Drain Fees
Floor Drains Storm Drain Fees
Hoppers Water Sys. Fee
Sand Traps Gas Piping Fee
Urinals Survey
Area Drains Permit Fee 1.,ao
Water Leaders TOTAL FEE 'v0
Trailer Space INSPECTOR'S REPORT
Swim Pool Gas Piping
ndirect Wastes Approved
)r well B
Backflow Preventer Partial
urvey Approved
B
Rough
TOTAL / 17,a0 Approved
B
Finish
Approved
B