17928 1523 JAMES TOWN DRC VE Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Pda.. — 7 7
Date................_... ....31....._.................. 19.--.8_ Permit No............�..l.........------...........
The undersigned hereb�akes ap lica�io��jjffo f fu bin }nsVefor of the City of San Jose
fora permit to install ihe�jegn �f'�oJk�led sgrsjf,
Exemption from requ 2 f f State a l orn(a for Cdnfracfor's License is hereby claimed
by undersigned: a owner ❑ statement filed ❑
Undersigned attests That his fate of California Contractor's License # 258540
is in full force and effect and psr- uthorix t!�is�ep is 1
San Jose City Business Lice ya ��/
I certify }hat in the performance of the work for which this permd is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER Robert Bloom
ADDRESS 1523 James Town Drive Lot No.
USE OF BUILDING Residence nnn` '
Signed--U�A.X-?<X'-"A..-- -'--
U 280-404n \
1523 eJAMES TOWN DRIVE VALLEY HEATING
Type ofOFEES
Appliance No.
Gas Ranges
Wall Heaters
Boilers (Steam(
Boilers (Wafer(
Blower Furnaces
Suspended Units
Clothes Dryers
I MIS Appliance Fee
Flues/Vents Fee
Flue/Vent Hood/Ducts Fee
Hood/Duct Gas Piping Fee
Condensate Drain I Cond. in
Permit Fee
TOTAL FEE
INSPECTION RECORD
Ducts Underfloor
Ducts Complete
Flues in Wall
Flues Complete
Appliances/Misc.
No. Gas Lines Outlets Size
Tested and Approved