18857 (2) Building Permit Confirmed
try ^ Not Required
CITY OF SAN JOSE U V/ H BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date.....5 /G 7 ......--- ---- . 19........ Permi+'No.........../I f K1 /�- ------ ..
The undersigned�I+er Pntfo,
9 pI' t2 to th PI mbi -fl actor of the City of Sen Jose
0
for a permit to mste I r listed' 7 r sa i2 a.
Esemption from requiState of aliiornia for Contractor's License is hereby claimed
by undersigned: as owner statement filed ❑
Undersigned attests that his State of Celifor is Con}rac}or's License #
is in full force and effect and properly authors�j-,(�) }h' d}spl!or,'
Ic
San Jose City Business License #
I certify that in the performance o thaw k which tlis rmit is issued I shall'nehemploy
any person in any mann s es to ' ate t w man's comp s 'on laws of Celiforni .
OWNER
ADDRESS ���G� �KPSTt`/il �}^ Lot No.
USE OF BUILDING
Signed...... . . .. .....
G19)CRESTLINE DRIVE nwnTFR 280-404n
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