294 1J y _3ay
BuildingPermit Confirmed ❑
s/1 Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
�/- 3 p
Date. -�._.r......../+--...... ... 19' Perjnrt No. - - ..... -- - -- ' - -
The undersigned hert`b� pl ion u spec+or of the City of San Jose
for a permit to install the mecha ical work lis+ed on the reverse side.
Esemption from requirement for State o al' nia for n}r cf r /o: s/},ereby�jclaimed
by undersigned: as owner /!�ff
Undersigned attests that his State of alifornia Contractor's License
is in full force ityd effect and properly authorizes his app» iop.-^
San Jose Cif Business License `/7`/� �' G/J/ 1
I certify that in the erformanca of the work for which +his permit is issued I shall not employ
any person in any man so as to violate the wo en's compensation laws of California.
OWNER
ADDRESS // U� / GV�J Lot No.
USE OF BUILDIAG_
Signed------- - - -------
280-30 s 0 �
1105 Milker Way tlas
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