16149 APPLICANT: BEAR DOWN. CAR60N COPY MUST BE LEGIBLE. �ATE ASSE6GOR`5 MAP NO. p.C. NO.
DO NOT WRITE IN SHADCD AREAS. J `L3 -? �C}
CHECK HERE IF YpU NEED A COPY P•G,,•,yR�E''&�IBI
OF TWIS ApPUCAitON IN ADbITION § ��""�^
Tp YOUR PEkM1T ANp kECEIPT � �"="•�T�H.qF�E�IxD
PERMIT REq'D IINbE6 FLOOD CON� a "l;:_-✓—
TR�I DI$T. OftD. 59�1 PERMITFEE(I) :'�� TX194PACEGOFMACHINEVRLIDPYION «T
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In coaformity wlth thv prov eiom ol Sectlon 70�7 5 of 1he 8us s an ra�e;slons ' — NS NOTE � •
Code and 5ection 3Boo of ihe Lo6ar Code of the Stoie of CeLf n a applicnnt sha11 e�oc. �rvsp. . . � � e�
. file wilh ihn Bwlding Inspector the cerlf6mtes,design4fed m (f} and �YJ below'�tind/ot �-.���G�..�W/��.d�-✓ �'-ff S+L/Q�N��
sholl indmate tem 13�, (4), �5f � 16� whichever is oppfwble. � .
p� CerllOmre ol Conwn� f Self Inmred� saed by the Pireclor of �nduslriol Helol ons. i � � � '� //�� � oAre
(2� Cerlifimre �m exncf d�piimie copy� o(Workmon's Campensation Insoronca isso¢d yij�s� �U . / � /// �� i ;,
by an odmiued Insurer }' " Qr��-•. /�/ ,p'.'4,. /✓,� S'L 'l Z
� p� The ms1 of ihe wa�k to be performed iz 5100 er less. �4p�rx oepY. av
�4J I cetlily fia�in fie performance of ihe work tor which ihie pe�mll Is issuod
ihu�I shail not employ any person m any monner ao ae fo become sobiect
m ihe Workmen's Campensa�ion laws oF Colifomia.
O �5� I [enily �ha! ihe epplicpnt is liceneod onder Ihe provisions of Chap�er 9 onr[
Immmencing ot Seci�on ]OOU� ol division $ of iha Bwineas anJ
Profeszionz Code, and sald appllcoN's Collfamia Siata ConYmalor's ticense
F.N4. 6ERVIGE9 BY
No. flazslllcaYion is in full force and eff H. �J
Q �6� ApA�icanl i, eKempl (rom (5� o6ove onder the applica6le pmvisio s of _ . oqrE
Sec�ion 7040 fimugh 7053 of tho Cont�octot� Licenf Law. �S1ala 6o is (er J
. exemp�fo . p J
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APPLICANT'S � pLANNING �4PT. BY
SIGNrtTUwE
A�OflE55 s��� �. . .�. .�.�{ � /'1•" D9TE q
6i.F„�+ ' . . .' .r:. . �e��'�6
COMPENdAYtON CERYIFICAT6 VENIFIEO FIflE MAfl9HqL ... ` BV
THIS APPLICATION IS A BUILDING PERMI7 WHEN PROPERLY FILLED OUT, �
SIGNED, ANp MACHWE VALIDATED IN THE SPACE PROVIDED. ' owre
PERMISSION IS THEREFORE GRAN7ED TO �O THE WORK INDICAT[D CONSTRUCTION LENDER
BELQW IN ACCORDANCE WITH ALL APPLICABLE ORDINANGES, iAWS �
ANp kEGULA710N5. NAME:
a • o e AOQAEGS'_._��
UNKNOWN: 9Y:
NUAkBEPp ry�q� �pppIICANYi �DONOTWRREINSHA�ED � INSPECTIONRE�ORD
0 M U y� ARfAS� BEAR pOWN
� PRINT OR TVPE -iHE 2nd GOPY IS YOURS DTTE �NSPECTOR HFMAHtt3��
Ai�PLICATIQN FOR 8111LDING PERMIT � FaUNowT�ON FORMS
2.FORMS
COUNTY OF SANTA CLARA POUR NO GONCRETE tINTIL THE ABOVE HAS BEEN SIGNEO
BNLDING INSPECiION DIVISION ��
SO WES7 NfUDING ST. • S0.N JOSE, 4ALIF. 9311tl • TELEPHON[ 999s351 3.Hennrvc-oucTs
LOCAYION 6.COMFORTCOOLING
LOT BLOCH TPACT O.GIPOEPB
srpeer a pDopess C �/j' � /� DO NOT COVER FLOORS UNTILTHE A60VE HAS BEEN SIGNED
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NEBFEST Cfl055 STREET RO G P B . �
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cONiqeCTOw /�' LIC. No. COVERNDWALLSUNTILTHEABOVHHASBEENSIGNGD
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