13440 918r ie•
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date. --L-. c ............. ..... 19. Permit No...........
._ _(....Y.. .
The undersigned hereby moes applicgfioF fo'the-,P1umJ�n Inspector of the City of San Jose
for a permit to install the mgdha sicrtjtrY'IisfoH'�rvjhe�r�`efsl side.
Exemption from req uiram�Lrt for S}ate of California for Contractor's Lipense,is hereby claimed
by undersigned: as owner ❑ /� sf♦t'C4c/erze XW/�
Undersigned attests that his State of California 6ofitrecfdi's�License �F
is in full force and effect and properly authorizes this application.
�
San Jose City Business License # /hi�_
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 _ -�
ADDRESS�S__t��j'
Qj� �� Lot No.
USE OF BUI�DING ? ��
Signed
280-4o4n
918 Fort Baker Dr_ Atlas Heati.na tr Vent_
Type of b-T.U. Remarks (Check V)
Appliance No. Input New Replace Relocate
Gas Ranges
Wall Heaters
Boilers ISteaml
Boilers (Wa#er)
Blower Furnaces
Suspended Units
Clofhes Dryers -
FEES
Appliance Fea O Zl
Flues/Vents Fee
Flue/Vent Hood/Ducts Fee
Hood/Duct Gas Piping Fee
Condensate Drain Cenci. Drain
Permi# Fee CT O
TOTAL FEE
INSPECTION -RECORD
Ducts Underfloor/f/-'t-�
Ducts Complete
Flues in Wall
Flues Complete
Appliances/Misc.
No. Gas Lines Outlets Size
Tested and Approved