11083 1135 HOLLY HEAD LANE
�47t—,uti( Building Permit Confirmed ❑
l✓�'f" Nof Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date--/ - I - ....- ....... 19�,° Permit No......`�..0 0 /
.._. .. ._.... - ... ..... ....._----------._..
The undersigned hereby makes appliceJion to the Plumbing IrLpector of the City of San Jose
for a permit to install t e meEFFam I rkkkl*98 o`the to so side.
Exemption from requir me entof� td-!ot`Cslior� ff�ontm Oars License is hereby claimed
by undersigned: las owner 0 statement filed'ny ��
Undersigned attests that his Stete of•Celiforni• f`ct�i�icense�� V (� /
is in full force and effect and prper���,� ap ica£ n,
San Jose City Business License �F
1 certify that in the performance of the work for which this permit is issu d I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER
ADDRESS; at 1CZ�8`
USE OF 'BUILDING a
Signed
280-20 (9-73)
1135 HOLLY HEAD LAX
Type of B.T.U. Remarks (Check V)
Appliance No. Input New Replace Relocate
Gas Ranges
Wall Heaters
Boilers IS}eam)
Boilers (Water)
Blower Furnaces
Suspended Units
Clothes Dryers
FEES
Appliance Fee
Flues/Vents Fee
Flue/Ven+ Hood/Ducts Fee clQ (J
Hood/Duct Gas Piping Fee
Condensate Drain Cond. Drain
Permit Fee d
TOTAL FEE _ Q
INSPECTION RECORD
Ducts Underfloor
Ducts Complete
Flues in Wall
Flues Complete
Appliances/Misc.
No. Gas Lines -Outlets Size
Tested and Approved