15259 (2) 1128 Derbshire Dr.
Building Permit Confirmed ❑
Nof Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
—� __ 19Permit No... ./..��.. ST
Date... ��......_.....___ �� l �.....----------------
The undersi ned h eb I' a}i th PDymbi%g/I ppg for of the City of San Jose
for a permit tc 9insiall fha� c'a w rll sial-o7ihe/ryV�e�f Sidi,
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as own�0' � i side an filts�
Undersigned attests that his State/O�Ca,IfoSma Con ^i/L�eQs� S
is in full force and effect and prop yfly a t o it' s,- pplrca}ion.
San Jose City Business License #' rr^
I certify that in the performance of the work for which this permit is issued I shell not employ
any person in any manner so a, to violafe the workman's compensation laws of California.
OWNER�t—J1 —
ADDRESS 142
USE OF BUILDING�.�S
Signed
Fondi 280-4o4n
1128. Derbshire Dr.
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