2850 8119 -Park Viiia
Building Permit Confirmed ❑
Not Required C—
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
DateDate
--......... / ,/......_....._. ...... 19..73. Permit No.-----------r/ l� -----....----
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to insfallf}ha�mechehicaliwork',ais+'ed on,the°roverse;sid.
/i�./:.7P�o/moue= 7
Exemption from regmramen}-for,$}ate of California Gfor':Confrac}ois 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�e pplica tion:_ l
San Jose City Business License # ��, --11 /:& h /, , 7vv
I certify Oaf in the performance of the work for which this permit is issued Fshall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER SCL-MA P E .Isaac.
ADDRESS_�1/ 9��r—V � ��-{rf ^° Lot No.
USE OF BUILDING�iI�FL"ur
Signed---i- _` --- ---------
280-20 (6.73)
Al IQ Park Villa Isaac .
Type of B.T.U. Remarks (Check V)
Appliance No. Input New Replace Relocate
Gas Ranges
Well Heaters
Boilers )Steam)
Boilers (Water)
Blower Furnaces
Suspended Units
Clothes Dryers
�16
FEES
Appliance Fee
Flues/Vents Fee
Flue/Vent Hood/Ducts Fee
Hood/Duct Gas Piping Fee 31)
Condensate Drain Cenci. Drain
Permit Fee 2—
TOTAL
TOTAL FEE 3 /
INSPECTION RECORD
Ducts Underfloor
Ducts Complete
Flues in Wall
Flues Complete
Appliances/Misc.
No. Gas Lines —Outlets Size
Tested and Approved