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20967 (2) 847 BETLTLV HVl1V UL PHONE: 277-4581 Building Permit Confirmed ❑ No} Required ❑ CITY OF SAN JOSE BUILDING DEPARTMENT APPLICATION FOR MECHANICAL PERMIT Date........QA^✓�u( 1/1-.... ........: 19-7.f— Permit No....... ..L.W -------------------- The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose {ore permit to install the mechanical work list e`d onf}he'�revariaiida. ' Exemption fromrequiremen}rio�`S}a}a o'California for=Cotractor's License is hereby claimed by undersigned: as owner g statement filed ❑ Undersigned attests that his State of California Contractor's License # is in full force and effect and properly authorizes fhisiepplice�}ion,7 Sen dose City Business License # ��,( ,!'/� 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 workman's compensation laws of California. OWNER1 oa d �2i ADDRESS �� � 4 S' `� Lot No. USE OF BUILDINGx�Cfc Signed--------- a�W-- ------ 2BO-404N 849 BETLIN AVENUE OWM1 m i U N Jt m LL Y IL LL d LL N O d C V C 4 0 Q E � Z " as x 0 U i K Z 7 E 0 r r d W 1 v N Z Z m 0 1