14700 1075 MILKY,WAY
Building Permit Confirmed 0"`
It Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR, MECHANICAL PERMIT
19 �7m ......�7 /oa
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Date.......0_ .... ... . Peri+ No. .
The undersigned hereb�yyy^���maIsyyy I' t' fo I nspector of the City of San Jose
fora permit }o Install th � m� sect
Exemption from requ men or $tate of Ca ifornie for Con}raclor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ /
Undersigned attests that his State of Cal' Conha//{{��r/I k�fy�g(q[��l'�
is in full force and effect and properly aufho '�e7 q is ap¢I�� V
San Jose City Business License # �7 e;,;c JZ�f///
I certify the+ in the performance of the work for which this permit,is issued I shall not employ
any person in "ny me r so as to .iolate f 4ork en's compensation laws of California.
OWNER
7 Lo+ No.
ADDR
USE OF BUILDING
Signed._.----....-----'-._ ...
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i 1075 MILKY WAY OWNER
280-4o4n
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