58818 (2) 1149 Derbyshire
Building Permit Confirmed ❑
Not Required
y 6-_ '� BUILDING DEPARTMENT
CITY OF SAN JOSE
APPLICATION FOR ELECTRICAL PERMIT
8 �\8
Date.-:✓ �L
-----�'f----- ---------..... - .. 197 . Permit No. - -- - --
The undersigned hereb makes ap ica 'o 1 gc ca n pecfar of the Cify of San Jose
{ore permit to install a ctr' a w g the reverse side.
Exemption from ra u' r fate f ernes for onfracfor's License is hereby claimed
by undersigned: As owner ❑ statement filed -
Undersigned attests that State of California Contractor's License #
is in full force and effect a�op +h rixes P }io res
San Jose City Business c
I certify +h a+ in the par rma of +ha work for which }his permi�is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER
ADDRESS
USE OF BUILDING
FIRM ./ 3Pee9401V4 -,! ['SIGNED / 2 /
1149 Derbyshire �_V S Brom
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