11545 1137 ROLLINGDELL COURT
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL
PERMIT
Date-----..._--------..............._--�-. - 1974 Permit No.11_Y..0-ts. ------------------------
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to inst t i li o r e sids.
Exemption fro n} to o C rn oVfractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ L,
Undersigned attests that his State of California Contractor's License # 3 > 7 6
is in full force and effect and properly au ias-this li ti°
San Jose City Business License #
1 certify that in the performance of a work for which this permit is issu�hall not employ
any person in any manner so as to violate theAmen's compensation laws of California.
OWNER s• ./� /�/��/`7nri 5// /�
ADDRESS .3� Lot No.
USE OF BUILDING
Signed.w.
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280-20 (9-73)f`""�'-\ �y„��,.,n_.
1137 iROLLINGDELI ;COURT,) WESTCO"INC.
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