15620 1168 GARDENSIDE LN
Building Permit Confirmexf�
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL .&o
PERMIT
�/
Date....._./ n-_ _.....__ .._.......... 19..f.. 7. Permit No..... --. .)
., . .C)
The undersigned hereby mak1s applic flof to�1he.Plumbing Inspector of the City of San Jose
for a permit to install the FIs ed/on��fhrzs�side.
Exemption from requiram6n} for S}a}eal4o!'nia for(Contractor's License is hereby claimed
by undersigned: asner ❑ s4e4emeni filed 3p 1 p l0 1
Undersigned attests the+ his State of CalifornVContra e'or)sl1�fc,P�rlse�
is in full force and effect and properly outho�ries his afplicafion.1 V l(6 �f
San Jose City Business License #' �^"' T� �'f " l?- d 3'102
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 C G s9 / 19 h7a[1— I (2r-1 I/
ADDRESSleaf c�enSi�Q n Lot No.
USE OF BUILDING�C e
Signed
1168 GARDENSIDE LN E.G. 'S ABYMAJVnSERV
Type of B.T.U. Remarks (Check V)
Appliance No. Input New Replace Relocate
Gas Ranges
Well Heaters
Boilers (Sfeam)
Boilers IWeferl
Blower Furnaces
Suspended Units
Clothes Dryers 'x
FEES
Appliance Fee .k;CMtP
I Flues/Venfs Fee
Flue, en+ Hood/Ducts Fee
Hood/Duct Gas Piping Fee
Condensate Drain Cond. Drain
Permit Fee rf-'�
TOTAL FEE
INSPECTION RECORD
Ducts Underfloor
Ducts Complete
Flues in Wall
Flues Complete g
Appliance Misc � (l—77 L
No. Gas Lines Outlets Size
Tested and Approved