18115 7514 HOLLANDERRY PL
Building Permit Confirmed ❑
Not Required E;--
CITY OF SAN JOSE Z BUILDING DEPARTMENT
APPLICATION FOR MECHANICALPERMITPERMIT
Date.....--------....._......................._..... 19.71}7Permit No../1/�-/-�-.....---........
The undersigned hereby,makes application to the PIusmbi�g Inspector of the City of San Jose
for a permit to install the me'chan'ical workalisted on the raverseisido,/
Exemption from req
uirement fo�tale of Celiforni. f, Con#r�or', Lice a ereby claimed
by undersigned: as owner ❑ statement (il
Undersigned affesfs ffia} his,t xerl -Califor1j. C�orn}1ctor's,Lic e
is in full force and effect and �p11
ropeily asithon es is . licatio
San Jose City Business License ; v� y
I certify that in the performance of the work for which this parmit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER L
//
7
ADDRESS / !L /7OLGFlN/ �i�'/ L
USE OF BUILDING ��oo
Signed. . ..
-/./.. ---- - -- --- ---- -- ---(l..._. v
28 -404n
7514 Hnl I AmnFPPY PI A Z H HTr, F_ A/r
Type of B.T.U. Remarks (Check V)
Appliance No. Input New Replace Relocate
Gas Ranges
Wall Heafers
Boilers (Steam)
Boilers (Wafer)
Blower Furnaces
Suspended Units
Clothes Dryers
FEES
Appliance Fee
MISC Flues Vents Feo �. l�
Flue/Vent ood/Ducts Fee
Hood/Duct Gas Piping Fee
Condensate Drain Cond. Drain
Permit Fee
TOTAL FEE �O
INSPECTION RECORD
Ducts Underfloor
Ducts Complete
Flues in Wall
Flues Complete -7
Appliances/Misc. V r�ti
No. Gas Lines Outlets Size
Tested and Approved