21362 1210 STA�Li O LRYV�i PHONE: 2]]-4581
Building Permit Confirmed
Not Requimcf
CITY OF SAN JOSE BUILDING DEPARTMENT
.APPLICATION FOR MECHANICAL PERMIT
Date...`.. 121.....–...._................... 1979. Permit No........._.....2.L.3 6.2_
The undersigned hereby makes applicafion_ fo the Plumbing Inspector of the City of Sao Jose
for a permit To install the mechanical<work lii}ed on-fheneyerse.side.
G o / ..✓ �'� v if'
Exemption from requiramen}�for SiaieSof`Celiforriie�for�Can}rector's Licepsa is hereby claimed
by undersigned: as owner ❑ statement filed4—
Undersigned attests that his State of California?Con}recfor's.Cicanse #y ,•
is in full force and effect and properly authorizes;this jipplicafion.%;
Sen Jose City Business License # O 3
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 yiolata the workmen's compensation laws of California. e3--ta
OWNER cT0 0cA QetA
ADDRESS 2�� �T�/l
USE OF BUILDING-�
Signed---'.'.... ..... ...G.....-----� - ' .
' - ------.
itv, OJ AZ7 t 200-404N
1210 STAFFORD DRIVE FIREMOUNTAIN
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