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23781 1129 ROLLINGDELL CT
Building Permit Confirme&—E�
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING �PPEERMIT
Dat e - .9/....1 ............ 197e.. Permit No. © ---- -
The undersigned here a es c fq/+�Alumbi nspec}or of the City of San Jose
for a permit to ins}all u (�js'iy6sfthe reverse side.
Exemption from req for Stale of Cali or
for Contractors License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of Californ' rat?,fn
o
is in full Force and affect and properly euihorixes is pylic i n.
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 T l 5—
- ca
ADDRESS s Lot No.aP
USE OF BUILDING — -
A & VALLEY PLUMBING
280-30(9-73) I Signed-------------------------------------------------------------------
P. 0. BOX 524 — SANTA CLARA, CALIF.
1129 ROLLINGDELL CIT A F ,f vel I FY
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