17666 1040 TUSCANY PLACE ?"�
A7✓� / yNo�t R quired i} Confirmed
CITY OF SAN JOSE �� BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PER/MIT
Date._....................:......._............... .. 19 ..... Permit No.._.. .. ..�:.. .... .......
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install the ��eni�work listed onrM6'1r�✓;8a.
Exemption from requiremen}4yr S 6�alifornia for Coniracfor's Lice n s heroby claimed
by undersigned: s owner ❑ statement filed //�J
Undersigned attests that his Sate of California Contffor's L��'__ey9nnse # .�Y / 74
is in full force and effect and properly autho�ri°/s i appllipicalioPOOSIV,
San Jose City Business License # 4?P,' - / .2 �C?\r
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner to as to violate the workmen's compensation laws of California.
OWNER �����n� ✓
ADDRESS ���� ����/1 Nf �L Let No.
USE OF BUILDING
Signed.... /..'.... '.... -- -.. .. ---�- �
280-4o4n-
1040 TUSCANY PLACE A & H HEATING & NIC
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