14525 870 FERNGROVE DRIVE �y
l/A Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
57Z-
Date.....g.... .../.J/ /�� A19. .
Permit No........... ..----_......The undersigned re mak s a'� pplFc 'Inspector of the City of San Jose
for a permit to install the mechanical work listed on the reverse side.
Exemption from requirement for Siete Aoj�elif rnie for C;tract License s he as, claimed
by undersigned: as owner (�/�� /_ �'
Undersigned attests that his State of ss'((✓✓alifornia�Contractors E-manse #
is in full force and effect and properly authorizes this application.
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 mannersoasI to violate the work.en'ss compensation laws of California.
OWNER-/�_ 1 .- CN S} I/F
ADDRESS 70 EaR V Lot No.
USE OF BUILDING
Signed-. (1L : ------
870 FERNGROVE DRIVE . IRan
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