10564 7538 KINGSBURY PLACE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date-..--'-S'4-`--�.............--...---- 19------. Permit No.......�tP.S7o.-.`!=_---
The undersigned here me kes a pl' a}i r 4o the 9, mbin specter of the City of San Jose
for a permit to insTall }I m a ' {e n e
se ide,
Exemption from req en e r S at o lit nie or on4rec4or's License is hereby claim ed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of Calijl5ftia Contractor's License # 17 (-T 37
is in full force and effect and properly aufhs applic � �/r , /
San Jose City Business License # Moat 1 Z b�'`/7�/
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner so as to.violate the workmen's compensation laws of California.
OWNER I t2G J 6 (_
C.T- G ADDRESS Lot No. Z
7S3 8 1�7.�c.t u a y Q
548 1 n
USE OF BUILDING /LEJ,
Signed---liJe/1 h d 52"iu CAS .9M -
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280-20 )6-73) I
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7538 KINGSBURY PLACE CENTRALSERVICE
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