76441092 November
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL P7/ER/�M'IT
Date .............. z -------------- 19.7J�Permit No........ ....40-/7----------------
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install the mechanical work listed on the reverse side.
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes this application.
San Jose City Business License #
I certify that in the performance of the work for which this permit is issued I shall not employ
manner any parson in any so 2
as 4o violate }yy workmen's compensation laws of California.
//
OWNER AA9Ze' =W L1-3? ilT-
ADDRESS 107, /1/kl, 22Z,� ///� Lot No.
USE OF'BUILDING
Signed ----- .."�� -
280-20 ;
1092 November McComb
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