20402 7558 fftAZfFf2ft 666 DATVG r_�J&�PHONE: 277-4581
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CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PEWIT
Dafe. _. t " . � 197c
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The undersigned hereby/,M4ka �ayy�lii to fh��e{r�PI ,�w}�n l�ctor of the City of San Jose
for a permit }o install the r�Fyhe'jFbl. or ion/"' f"•S��id�e.
Exemption from requirement (,01 State of California for.Con}racfor's License is hereby claimed
by undersigned: as owner ❑ sfatemen} filed 1:1. r� QQ KK / I//ll
Undersigned attests that his State of Cal' ornie C,on`f¢��)ol!A ansa[� SUJ YV
is in full force and affect and properly 'riles(]LJd ffj f /% y
San Jose City Business License # `�f/
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 .Sohn 8uek� 1
ADDRESS '155-3 �H a 44)E Uux)d J Lot No.
USE-OF BUILDING P—EStdU)
Signed.. .. . . - .. . . ........
r
80-604N
7s';r A HRATAR.RWnnn TIRTVR VAT.T.RV T-TRATTWC
Type of B.T.U. Remarks Check V)
Appliance No. Input New Replace Relocate
Gas Ranges
Well Heaters
Boilers ISieaml -
Boilers (Water)
Blower Furnaces I 1370M, ✓
Suspended Units
Clothes Dryers
FEES
Appliance Fee
Flues/Vents Fee
Flue/Vent Hood/Ducts Fee
Hood/Duca Gas Piping Fee
Condensate Drain Cond. Drain
Permi4 Fee 13-00
TOTAL FEE
INSPECTION RECORD
Ducts Underfloor
Ducts Complete
Flues in Wall
Flues Complete a L4
Appliances/Misc. 6
No. Gas Lines Outlets Size
Tested and Approved