11085 1135 HOLLY HEAD LANE D VAI-eyo 10N
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date---- --`-....f.!:..J ------..... 19 ,1 . Permit No...-....1-16-15 —_....._..
The undersigned her�y makes a plica#io�s to the PI 6' Inspector of the City of San Jose
for a permit to install t e m�ly�njerk +e� #hv jvafida.
Exemption from requrreasenf for State of-California for Contractors License is hereby claimed
by undersigned: �s owner ❑ statement filed ❑
Undersigned attests that his State of CaVforniaeCon#racVr's lzic s
is in full force and effect and properly autxe`this aPplicatton�
Ln Jose City Business License
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner soo as to violate theworkmen's compensation laws of California.
OWNER ria
ADDRESS f��0 '�of No.
USE OF BUILDING
Signed. ...,.. - \ _ .—�-----
280-20 (9-73)
1135 HOLLY HEAD LANE &' BU LDERS-
Type of B.T.U. Remarks (Check V)
Appliance No. Input New Replace Relocate
Gas Ranges
Wall Heaters
Boilers (Steam) .
Boilers (Wafer)
Blower Furnaces
Suspended Units
Clothes Dryers
FEES
Appliance Fee
misc. Flues/Vents Fee
Flue/Vent Hood/Ducts Fee
Hood/Duct Gas Piping Fee
Condensate Drain Cond. Drain
Permit Fee Z
TOTAL FEE
INSPECTION RECORD
Ducts Underfloor
Ducts Complete
Flues in Wall
Flues Complete
Appliances/Mist. d
L ' boa VN
No. Gas Lines Outlets Size
Tested and Approved