5577 7408 Fallenleaf
/ Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL^ PERMIT
nRMIT
Date......------------�G-..a2� - 19;7/'-/ Permit No.........J_.��../._--------------------
The undersigned ,arab makes application to the Plu7 Inspector of the City of San Jose
for a permit {o ins}all t a a r a n rVv rs� side.
Exemp{ion from ra 'lifnf:n for $r�-Galifor�Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests {hat his State li#p�srib `( a4o3�2
is in full force and effect and properly a r' s I iis��p�{ a4,
(wa.(/
San Jose City Business License .# Q 2.
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 workmen's compensation laws of California.
OWNER_�{ 2 _� 4�/S
Lot No.
ADDRESS
USE OF BUILDING L�Fs/�EnJC6
i Signed !f: -----------�.1.... .. ..--- �_
280-20 (6-73)
9408 Fallenleaf TanP. � f� /FI�r/EL /✓�
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