NO PERMIT NUMBER 6772 JOHNf DRIVE
Building Permit Confirmed.Q�
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION
� FOR MECHANICAL PERMIT
Date.� Z` .. /.. 117.7 Permit No............. ----- ........ ...... - ----
The undersigned hereby makes application t the plumbingInspectorof the City of San Jose
for a permit to install the/ < �i`�oyr1/dsdloJr�tfr� oriels
Exemption from requirement for Sfate df California for Contrac}or's License is hereby claimed
by undersigned: 6i owner ❑� statement filed ❑ /
Undersigned attests that his State of Catifwnia Con tri c}o�s�kf'ben1se- [/ 6 -15—
is in full force and effect and properly aut oris ihil�lfca i n,�J�-�j
San Jose City Business License # l/
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any mann so as to violafa }ha workm n's nsation lows of r•;ifornie.
OWNER � �J�j
ADDRESS _ Lot No.
USE OF BUILDIN
Signed........ 5-
r
28o-4o4n
(,779 ,InHMO( hRTVF
Type of B.T.U. Remarks (Check V)
Appliance No• Input New Replace Relocati
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 .�
TOTAL FEE
INSPECTION RECORD
Ducts Underfloor
Ducts Complete
Flues in Wall /
Flues Complete
Appliances/Misc.
No. Gas Lines Outlets Size
Tested and Approved