11560 7554 HOL�ANDERRY 9
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
G 7 < //J-G. °------ ----
Dafe....-------l�. -.-_.-_................___ 19.....-.. Permit No.--... _ .. -
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install the mechaoic9� orktlisfed)0%;t.H�ers�i�de,
Exemption from requiremedt for State of�Californw/for Con}aftor's License is hereby claimed
by undersigned: as of ner ❑ statement filed ❑
Undersigned attests that his State ofICalifornia Contractor's License #
is in full force and effect and properly autho u this applieatio/
San Jose City Business License $k
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner $ as to violate the workmen's compensation laws of California.
OWNER !9 r✓LLL
ADDRESS �S -IO �I/l Nom/ Lot No.
USE OF BUILDING CQ>
D
s(geed---/:.�--l�l�---C cs.. ...q---�..C..J
280-20 (9-73)
7554 HOLLANDERRY A& H HEATING &A/C
Type of B.T.U. Remarks (Check V)
Appliance No. Input New ;place Relocate
Gas Ranges
Wall Heaters
Boilers (Steam)
Boilers (Wafer)
Blower Furnaces Q
Suspended Unifs
Clothes Dryers
FEES
Appliance Fee , Q
Flues/Venh Fee
Flue/Vent Hood/Ducts Fee
Hood/Duct Gas Piping Fee
Condensate Drain Cond. Drain L
Permit Fee Q2, 0 0
TOTAL FEE • `� O
INSPECTION RECORD
Ducts Underfloor r
1
Ducts Complete I
Flues in Wall
Flues Complete
Appliances/Mist.
No. Gas Lines Outlets Size
Tested and Approved