18564 7536 HOLLANDERRY PL �\\ ����
s✓� Building Permit Confirmed
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICALPERMIT
Date...�(5....""...../._--..._ ---_.. 19 )J Permit No— ...... e.-*�
Tha undersigned here�y�makes application to the Plumbing Inspector of the City of San Jose
for a permit to install the
e m/ehan caje/rte is✓'Jo he�so j��
Exemption from ragm amen}.Q Stafj�o Cabfo/nia/for Gontraefor's License is hereby claimed
by undersigned: as owner 0 statement filed 0
Undersigned attests that his State of Calif �ornia Contractor's License # � ��j /J
is in full force and effect and properly aufho/'ins-this application. �
San Jose City Business License #�
I certify that in the performance of the work for whichh fh 10,ssued I shalll not employ
any person in any manner so as t 'olate the workmen's compensation laws of California. 57d._
OWNER
ADDRESS—l� �_./_� �.e�C' _ _ L t N
r
USE OF BUILDING
tis, �/a„ Signed -.....--
/"7 280-4o4n
7S�;F, HFII 14NnF:PPY PI A f_ 4 RI IT MRoc
Type of B.T.U. Remarks (Check V)
Appliance No. Input New Replace Relocate
Gas Ranges
Wall Heaters
Boilers ($team)
Boilers (Water)
Blower Furnaces
Suspended Units
Clothes Dryers
FEES
Appliance Fea
misc. Flues/Vents Fee
Flue/Vent Hood/Ducts Fee SFO
Hood/Duct �^ Gas Piping Fee
Condensate Drain Cond. Drain �t
Permit Fee
TOTAL FEE 4'rd
INSPECTION RECORD
Ducts Underfloor
Ducts Complete
Flues in Wall
Flues Complete
Appliances/Misc.
No. Gas Lines Outlets Size
Tested and Approved