11567 ft=TNd52LL COUAT
Building Permit Confirmed ❑
Not Required Cl
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION 7FOR MECHANICAL PERMIT
Date..-----------......._...........-&--- 7...... Ig--7C Permit No. ---------------------..---
The undersigned hereby me s application to the Plumbing Inspector of the City of San Jose
for a permit to install the me a 7��}ry�f re rs s7
Exemption from require e,e'j I n� a r' icanse is hereby claimed
by undersigned: as o or ❑ statement filed ❑
Undersigned attests that his State of California }r�c,kor s Li rsa # �G
is in full force and effect and properly authorizes 'UUa4pFicatio .
San Jose City Business License # /
1 certify that in the performance of the work for which this permit is issued I thall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER o c�-�d�-- �o
ADDRESS i/3�. /a,7— — Lot No. ti—
USE OF BUILDING 5---
Signed......� �r �t1i �rjy �'%If �� {`i------------
280-30
1136 ROLLINGDELL COURT LAH9.• J4 VA`L-EYdBILZM5![NG
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