69662 (2) 95$9 Prospect Building'Permit Confirmed
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPIINGG PERMIT
Dafe----------- .................. 194, Permit No.--------------- -/...LL..Z.......
The undersigned hereby makes aEplieation to the Plumping Insp'ctor of the City of San Jose
for a permit to install plumbi ger{if}ur��n Tor plpot sfiod � reverse side.
Exemption from requiremtlf Ior���afe o��rf2niaaf4Confractor's License is hereby claimed
by undersigned: asrowner ❑ statement filed ❑
Undersigned attests that his State of California contractor's License # -o DZ
is in full force and effect and properly authorizes ) s application ,//
San Jose City Business License # -T _;Ace o
I certify that in the performance of the work for which his permit is issued I shall not employ
any person in any ma ner so as to folate the workmen's compensation laws of California.
OWNER Q_T ti L,LC41�
ADDRESSv
USE OF BUILDING
FORM 20030 (REV. 3I661 IOM — �� .r....G .�. �.�iO���`y`�
Signed
7585 Prospect
�� Walker�
FIXTURES FIXTURES MAIN DRAT
Water Heaters / Floor Drains Size Material
Water Closets ,3 Hoppers To To Septic Tank
Bath Tubs / Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size / " I Material
Lavatories 41 Area Drains To Curb I To Main Sewer
Kitchen Sinks / Water Leaders WATER SYSTEM
Dish Washers Trailer Space Size /�, Material
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee , o
Washing Machines / DrywelltMain Drain Fee
Wafer Treat. Equip. Backflow Storm Drain FeeSinks SurveyWater Sys. Fee G
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial (�_�- -G 0 k I No. Lines Z Outlets Size $/
Rough �' ,'�' / -7 477(-^7/-ff44 e Tested and Approved WS J L-7
Finish / .(97 /' �( By
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