11545 1128 ROLLINGDELL COURT
Building Permit.Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date------------------------.--E. [./------ 197_6 Permit No.-..//-5t/$ ------------------
The undersigned hereby a p' a}ion the Plumbing.Inspec r of the City of Sen Jose
fora permit to install the
a 7J ev s i
Exemption from requi nt r S ate o aliforni for on rac or's License is hereby claimed
by undersigned: s owner ❑ statement filed /
Undersigned attests that his State of California f9BJJJ��r or.s JJ' s O
is in full force and effect and properly eyfhori:es � OI'ic.""'o
San Jose City Business License .# L� 7 0
1 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 cC D
ADDRESS / L4� Lot No.
USE OF BUILDING
`280Signed---
280-20
-20 (9-13)
1128 ROLLINGDELL COURT ES76j"'PNC:'
n S T
Y• m �
m n m m o a
O
`m \ l 2 Z
CL N 1 o
O C C o
7-1C
poJ
n,
T i
N 0
p \ < E a
!�
3
O T
u m
Ir
r5 ri
O_
A
6
m