11545 1115 ROLLINGDELL COURT
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL ``PERMIT
Date..................D...-- /----......_._... 197.. Permit No------ /.1 ..L.��/ -----
----... ....
Th. undersigned her me kas a plic ion to the Plumbing Inyactor of the City of San Jose
for a permit to install a c y w d yr7p�ar� A.,
Exemption from r ' e ✓ I r of 9 ifora actor's License is hereby claimed
by undersigned: as owner ❑ statement filed �/
Undersigned attests that his State of C ern is Contractor's License # /'7 ( 6 7
is in full force and effect and properly
San Jose City Business License #
I certify that in the performance of the work for which this permit ivissued I shall not employ
any person in any manner so as to Yiiol�affee�thhee workmen's compensation laws of California.
OWNER
ADDRESS TJ �` { � Lot No.
v
USE OF 'BUILDING
Signed �t'_f-A ----.A1�---e .-. ----------
zao-zo.l9.�."
1115 -ROLLINGDELL COURT WESTCOjcINC.
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