8284 1128 Obsrdi> n Court
-ti
• Building Permit Confirmed
Not Required ❑
CITY OF. SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date. 12-. 3-�s `L 8 Cf
_.....-- ..... - - ........_......._..- 19 .:... Permit No. - - ... ...... ...._._..._..
The undersigned hereby makes application to the Plumbing-inspector of the City of San Jose
fora permit to-insfalV}he medhanicnl work Iiifa'd on°ihe reverse side,
Exemption from requiremanT�foP'Sfete o4 Celiforri is for Contractor's License is hereby claimed
by undersigned: Or as owner ❑ statement filed ❑
Undersigned attests that his State o�California Contractor's License #'110828
is in full force and effect and properly"//eu}sies Ihi6pplica/t �./J n
San Jose City Business License � 7746-0�(ZQ%�(�'
I certify that in theperformance of 0e work for whick this permit isaiisued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER ponderosa Homes
ADDRESS 7728 Obsidian 'Ct. Lot Noil
USE OF BUILDING Res
5R60-ZA4('b.63') 5HEETfMAL v4ORKS 5�
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77287abs' ian,� ROAD
ouM san Carlos s/m
60 m m m 0
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