11545 1120 ROLLINGDELL COURT
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
pp / SS--S
Date---.....---.._--..._ ... 4........r'J..�._�.._.. 19Permit No.---//----._..-----...----------......---
The undersigned h by mWo.ner
n to the Plumb i Inspector of the City of San Jose
for a permit to ms} f ion e ey��sida-
Exempiien fro i a if rn f onfractor's License is hereby claimed
by undersigned: statement fil;
'
Undersigned attests that his State of Carnia Contractor's License
is in full force and effect and properly eufho ' i a a /J/
San Jose City Business License $�' `�Y'' �(/
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 viol to A workmen's compensation laws of California.
OWNER
ADDRESS �/ (lS ��p Lot No. j
USE OF 'BUILDING �
SignedL(/... ..... '- - ---------------
280-20
----...-----280-20 (9-73)
1120 ROLLINGDELL COURT WESTCO INC.
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