9473 1169 Elmsford Drive �
BVI Building Permit Confirmed �
Not Required �p
CITY OF SAN JOSE BUILDING DEPARTMENT
PLICATION FOR MECHANICAL PERMIT
Date--- :..._.. 0./..----- 197". Permi+ No.............--- - -------
Thundersigned hereby�t appl�Epfio, -io f�hay Plup�ng�lnspector of the City of San Jose
fore permit to install the ((nneahha ic�l wo k� jonyfhVr vats side.
Exemption from requiremenf for State of California for Contractor's License is hereby claimed
by undersigned: as/owner a� statement filed ❑
Undersigned attests that his Sfaf f-Califor JJJJJJ'a Co tfe toKL' ansa # 0276 3G 9
is in full forrce and effect and prop�l�uthprj tFVsf Q_�,ifye}'so7�.�
// LL�I
San Jose 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 m� r so/ems to violafe the workmen's compensation laws of California.
OWNER
ADDRESS �6 9 /, �m S �v C/ Lo+ No.
1
USE OF BUILDING S `r J.y��J
Signed.. _ ✓1�--A�.t"....11----- ';`-f�''---------'
280-20(9-73)
1169 151msford Drive L '�1ESTERN A C & SM
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