16156 (2) 852 BETLIN AVENUE
Building Permit Confirmed ❑
Not Required iti—
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date....Z..0:) _oc:\\-....__....... 19.7.7 Permit No._✓.G. ............... ...................
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install the mechamcalsvwork�listaron }he 'rever7e�iide'�
Exemption from requiremenftfoidSf}of'Califo oia f.V6o}radtor's License is hereby claimed
by undersigned: as owner X statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes thippefion ���
San Jose 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 workmen's co{npensation laws of California.
OWNER (a\(MC)VSD ` 16n0 C`1
ADDRESS W -T11 ✓� Lot No.
USE OF BUILDING
Signed .. .. ........ ---- --
852
852 BETLIN AVENUE OWNER
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