14842 (2) 1128 DERBYSHIRE DR J /
Building Permit Confirmed ly
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR
�7MECHANIC /A/L/�PERMIT
Date.........._...._!d_-./J......._..... 19/.7 Permit No...-/! 4.-L................----
The undersigned hereby,,���{{{{{^^^^^e es a$P�s efi n�x, }h POmbin 0tns ecfor of the City of San Jose
fora permit to ins}ell 4h �f��pre s�•
Exemption from req rc m t f{$tate o Ca_rifddr ie f�((Caefemen4 sfileLicense is hereby claimed
by undersigned: qS owner Cl /�/ ,0 3 2 3
Undersigned attests that his State of California Contractor's License
is in full force and effect and'propsrly aufhhoorises }his ap licaf'o ..�
San Jose Ciiy Business Lic ns �y � �
I certify that in the perf r an�eca the k f Ms 01?-issued I shall not employ
any person in any manner s/oo//as to violate 4h orkmen's compensa}ion laws of California.
OWNERTQ�_r
USE OF BUILDING��-/
r
Signed ....// .- .. _..... ... .. - ... -. ---....
'VE -N,9,A2- CC'Nl3^/-404n
1128 DERBYSHIRE DR DEL MAR CONST
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