NO PERMIT NUMBER 960 November
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date-------------- ------- ' .....
' '-(Z- --- 19.(..? Permit No.------._-----------------------------------
The and gned he by makes applicgiio to fhe PlumbingInspector of the City of San Jose
fora permit to install lu bin u �efi Ip=s u d on ��+W/�-'se side.
Exemption from requir me" flo e a ifoiriia racfbr's License is hereby claimed
by undersigned: a owner ❑ statement filed ❑
Undersigned attests that his State of Cel jorn is Contractor's License #' ,
is in full force and effect and properly euih� si ss app s' � 5
Sen Jose City Business License # � �
1 certify that in the performance of the work for which this permit is issued I shall not employ
any person in any man/n/e� as t .01afe the s a kmen's compensation laws of California.
OWNER
_ �Lr—
ADDRESS —6-1L(61) L PJ
USE OF BUILDING
FORM 280-30 !OM 3/67 Signed--------------- -----------------
I
960 November Pierce
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Material ••
Wafer Closets Hoppers To To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size Material
'Lavatories Area DrainsTo Curb To Main Sewer
Kitchen Sinks Water Leaders WATER SYSTEM
Dish Washers Trailer Space Size Material
Waste DisposalsjInc!firect
im Pool FEES
Wash Trays Wastes Fixture Fee
Washing Machines Main Drain Fee
Wafer Treat. Equip. Prevenfer Storm Drain Fee
Sinks Water Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee 0�11 61D
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines Ouflefs Size
Rough _ Tested and Approved
Finish '' (,F� a / ,gyp.�/l By