20967 847 BETLTLV HVl1V UL PHONE: 277-4581
Building Permit Confirmed ❑
No} Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date........QA^✓�u( 1/1-.... ........: 19-7.f— Permit No....... ..L.W --------------------
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
{ore permit to install the mechanical work list
e`d onf}he'�revariaiida. '
Exemption fromrequiremen}rio�`S}a}a o'California for=Cotractor's License is hereby claimed
by undersigned: as owner g statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes fhisiepplice�}ion,7
Sen dose 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 workman's compensation laws of California.
OWNER1 oa d �2i
ADDRESS �� � 4 S' `� Lot No.
USE OF BUILDINGx�Cfc
Signed--------- a�W-- ------
2BO-404N
849 BETLIN AVENUE OWM1
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