21804 (2) 66ES°TATE5_Dftm PHONE: 277-4581
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL (PERMIT
Date... ... _.---I�/ � ?.I...._..._._. 197y. Permit No.......:Zl. d.C1.......... .....
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install the mechanical work listed on the reverse side.
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License # niJy —
is in full force and effect and properly authorizes this application.
San Jose City Business License #
I certify that in the performance of the work for which this permit is issued I shall not employ
any parson in any/fan/ner so as to violahe the workmen's compensation laws of California.
OWNER�7ol�J
ADDRESS Slv a �.�/ '� Lot No.
USE OF BUILDING Q
Signed---- - -- -- ---- --------- ----- ---- -----------_......._...---
j2�P«c��sT.
280-404N
862 ESTATES DRIVE FIREPLACE DISTRIBUTORS
i m
A
_ U
7 °
d
y 'K
u
m v
L U N
U 4
a w m m w
�ir N LL O LL IL Il. LL N
_c > 1 r 0 O
!LZOII
U om K
Z
~ F
°D -E
U O
W
d
O N
Z Z
O
1 $0 v ° a
Q
CL
° c o m `a a u a N a '�
E 3 E :J v
c ° O u `
M U c U c m
m m m LL LL Q Z 0