115671112 ROLLTNGDRLL COURT
CITY OF SAN JOSE
Building Permit Confirmed ❑
Not Required ❑
BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date --- ..............._._....--.g............... 19.2.1. Permit No. --------- A�-6�-- ----- --- ---- --
Tha undersigned JrcrVaby- makes a lice ion fo h� Plumb' spec}or of the City of San Jose
for a permit to ins l/}9/oyeAA ic �s} o re � ida.
Exemption fr a i of ate o aK ornia or onfrac}or's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of Calif is �an}rec} is License #
is in full force and effect and properly aufh a - ale
Sen Jose City Business License #
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 -,x,- r
Ge
ADDRESS �X /�Oe ,a i:7,. Lot No. cP�
USE OF BUILDING
Signed -- --------------------------------------- & --VALLEY. PLUMBING
Signed
ROLLINGDELL COURT A &BJ VALLEYTPLUNMNG"
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