41645 (2) 1203TAP00
Building Permit Confirmed ❑
Not Required e—�
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBI�N�G and/or GAS PIIpPIIN.G�jPERMIT
Da+e. �/L�� .- -- - 19L Permit No..�'( '. ...J..^'.-_.......
TH undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbing fixtures and/or pipes listed on the reverse side.
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ sfatement filed E]y
Undersigned attests that his State of California Contractor's License # a
is in full force and effect and properly authorizes this application.
San Jose City Business License #,"� Q� 6
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any�anner o as to violate Fg wm a ponsation laws of California.
OWNER tel` i✓3 /
ADDRESS 63 Lot No.
r T—
USE OF BUILDING o »
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1203 STAFFORD A.B.TERMI740CM&OL
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