16858 Lk
865 BetteAve Building Permit Confirmed
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL
j� PERMIT
Date _.......-_ .......... 1978- Permit No.._...{.- != ..................
The undersign her es i n } he pl in pe or of the City of San Jose
for a permit }o sial rk a on Ah r se si
Exemption from requir ant for $fate of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed E
Undersigned a este that his Ste}e f Ce iforni Mrs 4 dense # 34?891
is in full force a fe f and prop y a f nx 31r/Cn a ion.
San Jose Ci u'7" .
ss Licensa, Al ( �
I certify } at in a performance of the work for whi?Irlhpermit is issued I shall not employ
any person in any manner so as to violets the rkmMtQ en's compensation law of California.
OWNER� �
ADDRESS g�o r r h ���` Lot No.
USE OF BUILDING Q�
Signed
/cif c y w !N
280-4o4n
865 Bette Avec Fire Mo>intain
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