11567 1128 130Y,Y�Yt5G1��Y,Y� CD�i13�'
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date............ ....................J3..' _..... 19.7b. Permit No.------f.� .................
The undersigned here ekes a pli do o t�Plymbing I spec}or of the City of San Jose
for a permit 4o install } e Fj!t a s' e.
Exemption from req cram or S e of Cal o ni for tractor's License is hereby claimed
by undersigned: as owner ❑ statement file
Undersigned attests that his State of California;?l"tr�ee,rfor's L'
is in full force and effect and properly au}horixas /applica i
San Jose City Business License # / l� —o7o
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 Pc a �•• .
ADDRESS Lot No. fe
USE OF BUILDING
Signed....A-&-�----ALLEY PL-------------------------------
280-30 P, Q BOX 524 - SANTA CLARA, CALM
1128 ROLLINGDELL COURT A & J VALLEY PLUMBING
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