115451112 ROLLINGDELL COURT
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date ------- .....................-.-----B--Y.. 197!6 Permit No..��.
The undersigned h reby m es application to the Plumb Inspector of the City of San Jose
for a permit fo ins gal k oR eJ'se side.
Exemption fro ��t for 4e of '.1; d WContracfor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ L,
Undersigned attests that his State of Cal��j{'.f.,,00rnia Contractor's L�ense �/ 7 7 97
is in full force and effect and properly au"& a, liC�to� 4
San Jose City Business License # �/J-] �(+f
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 4o violate the workmen's compensation laws of California.
OWNER
ADDRESS
USE OF BUILDI
Lot No.
Signedx.--
290-20 (9-73)
1112 ROLLINGDELL COURT (/ WESTCO,HTG-Z—& A/C
T
C
w
m