19358 6309 Bolling `i�
Building Permit Confirmed ❑
Not Required qe—
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR-LU BING and/or GAS PIPINryG PERMIT`
Mi
The vnd.r,i ed` or e a do o gb mpector of the City of San Jose -
for a permit to - g - u is
a or pipes fisted on the reverse side.
Exemption from requir mart for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ 3o
Undersigned atlas the State o Califo nie o o s icense #
is in full force and of c the
perly h ix s hi 'cef
San Jdse Cify B s L' arse #
I certify that in a per ormance of a wor for w ich i s rmit is issued I shell not employ
any person in any manner so as to violate the workmen's corApensation laws of California.
OWNER ?/1�'
ADDRESS �/� �7/ Lot No.
USE OF BUILDING
- 280-30(9-73) Signed . t -------------------
6309
LGlu -- ----- -- ----- '--------
6309 -
�
Bollinger Road Pop- r ,Plbg.
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