97621092 November (Derive' 9
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR ��7MECHANICA((��L %PERMIT
Date ............. ........... - / 19. G. Permi# No......L..../..... �.. -- - -------
The--
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 whit Phis permit is issued I shall not employ
any person in any man 9et so p5 tool ethe ygrkmen's room pensation laws of California.
OWNER
ADDRESS
USE OF BUILDI
Signed
2BO-20
1092 November Drive Owlner
Lot No.
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