13552 765 PEACH BLOSSOM DRIVE �l-'I(Building Peit Confirmed
�/1('ee P.m
it
Required
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CITY OF SAN JOSE t BUILDING DEPARTMENT
I
APPLICATION FOR MECHANICAL PERMIT
Date....---`----^_�0........_�. n...._._ 1977 Permit No.----- .......{..3s.l-..Z---
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The undersigned hereby makes application fo }he 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 Sfafe�of California for Contractor's License,is hereby claimed
by undersigned: as owner�C>,e°' �statementZfili'd$El.
Undersigned attests that his State o�Celiforni. Contractors License #7291 'gg Q
is in full force and effect and properly authorises this applpice}ion.
San Jose City Business License # 47 o r �a C�
I certify that in the performance of the work for which 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 / AC(�a f
ADDRESS (,GJ 3 0 e2 o55e d Lot No.
USE OF BUILDING '5 ( ° y
Signed (, ..... .3 ----- -c-----
(4117�-A11LI(�n�n���f�
7653' PEACH BLOSSOM DRIVE ( FTESEN4EOM T.
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