3390 375 Primrose Dr.
Building Permit Confirmed ❑
Not Required -�
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL 2PERM/IIT
Date....... ......... ._.... 19 ... Permit Nom......_.7..��`'
-3
The undersigned hereby mekes�application to the Plumbing Inspector of the City of San Jose
for a permit to install the mechan�al work listedron the reverse side.
Exemption from requirement for State of California for Contractor's,License is hereby claimed
by undersigned: as owner ❑
Undersigned attests that his State of California Contractors License �2—I
is in full force and effect and properly authorizes this ap licafion. I
San Jose Cify Business License # / 2 ���
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner soas to violate the workmen's compensation laws of California.
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OWNER Ad#?(-V A/ t�
ADDRESS ' ' FYI SE �ti° • Lot No.
USE OF BUILDING
Signed.. _... .. " 4
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