12283 7565, 130LLINGER ROAD
Building Permit Confirmed ❑ '\
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
.APPLICATION FOR MECHANICAL PERMIT
.� �
-------- ----------- 1970/
Perms+ No...._ _...------- --------...-------
The under0 i al treby makes applicationo the PI ing Inspector of the City of San Jose
for a permit to i a 1h c or si n } rse side.
Exemption n o ali i Contractor's License ereby claimed
by undersigned: a,.owner ❑ staiement filed Er
Undersigned attests
ha} his Safe of California Contractor's License $� a,1 gay
is in full force and effect and roperly auihorixes fl1illca oonn. /
San Jose City Business Li nse
I certify that in the per! enc#Cthe work for which th s rmii is iss ed I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER p
ADDRESS W3 �OI/n//� �1^ ILC Lot No... .�
USE OF BUILDING DL.,ed "0 /
Signed �!
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(6-73)
BOLLINGER ROADSC1 R Sfi� ]'Ti'tE4`AYPTING CO.
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