12283 (2) C7-5.7-3'BOLLINGER ROAD '
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR 7/MECHANICA/L. PERMIT
Date. AD .................... 19.6. Pernni# No.--{- - - ------.........
The undersigned r by as pp ati n t the Plumbing Inspector of the City of Sen Jose
for a permit to insT e k sfe�n�re�{ versa side.
Exemption fro a ant e f or Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed 0� -
Undersigned attests that hk State of Califor Confracfor's License .#_c2L790q
is in full force and effect Loaf{lro�autho i s f 's p �90,'y
San Jose City Business L.'LJ_nJse
I certify that in the performance of iha work for which f is ermit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER bLrY1P_ P(t� nfi r rl5 �nG•
�2'17 � 6III Cad Lot No.
ADDRESS I, �
USE OF BUILDING
Signed-- -- - --`--'-- - - - - --`--------
280-20 80YER tIL
47,9D,733D7BOLLINGER ROAD BOYER HPrM MU
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