11961 1137 ROLLINGDELL CT
Building Permit Confirmed-J'4-�
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL /PERMIT
Date----'%��-----'--------- ............... 19zG--
Permit No.----- (...G.-S/C/-/.. .......----
The undersigned here m e e ica ' t the PI Ismg ctor of the City of San Jose
for a permit fo install ih� y th r ar id .
Exemption from requ ment r Sfete d elif role o o actor's License is hereby claimed
by undersigned: as owner ❑ fry s,i�a-ffeamen} fil d ❑
'Undersigned attests that his State of California Centy'6li . Licen
is in full force and effect and properly authorizes this a li ion.
San Jose City Business License # � 9Ay
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 7 s c- sem
ADDRESS Lot No.
USE OF BUILDING_ S `�
si9�ed......A &�1 VALLEY PLUMBING
280-30 P_ 0, BOX 524 - SANTA CLARA, CALIF.
1137. ROLLINGDELL CT A & J VALLEY
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