10563 7495 MOLTZEN PLACE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Dafe----------------- 4------------------.. 197. ?. Pernnif No........-..
The undersigned he m ke a to } Pplu bi spector of the City of San Jose
fora permit io install a is s}ed a
Exemption from r mreme for e o if r r onirattor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of Ci&rnia Contractor's License # ] -71 } 7
is in full force and effect and properly aut n s isOappplic ion. �' /-�c.��
San Jose City Business License # �lJ�—
I certify that in the performance of the work for hiffi 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 T;t 6jKj a L(,jiQA(.i - '0
J¢6b ADDRESS -749S— Vq t hr-�6-A/ a/C, Lof No.
USE OF BUILDING dFJ'
Signed-----&&h,2l-c3RAUkR-VPD.r kc------
280-20
-- -280-20 J6.73)
7495 MOLTZEN PLACE CENTRAL SERVICE
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