9962 1158 Scotland Dr.
Building Permit Confirmed--El—
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date------------------------------/. 5--- 197. . Permit No.---------- .1..4'".-------...-----
The undersigned hereby ke ep lication to the Plumbing Inspector of the City of San Jose
for a permit to install plum n / ipe n reverse side.
Exemption from require of to a o n clot's License is hereby claimed
by undersigned: a owner statement filed]
Undersigned attests that his State of California Contractor's License #.1Z -'t'�--
is in full force and effect and properly,eyt o it tis
San Jose City Business License
1 certify that in the performance of the work for which this permit is issued I shgTl not employ
any person in any manner soas to violate the workmen's compensation laws of California.
OWNER�j o/G'i✓'5CW)I y
ADDRESS J co C/ Lot No.
USE OF BUILDING
280 30 I Signed .. .. PC..: - ----- --------- -----------------
1158 Scotland Dr. Apache Pool
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