6193 (2) 1195 Gardenside lane
Building Permit Confirmed ❑
qNot Required
CITY OF SAN JOSE ` BUILDING DEPARTMENT
APPLICATION FOR M.f-CHANICAL PERMIT
f �j
Date............... �' ��. ................ I - ._ Permit No---------10.. .7. - -------------
The undersigned hroby mak As appli ca to the Plumbing Inspector of the City of San Jose
for a permit to instalfh eica k}list9d dp r he. ase side.
Exemption from uquvo/'J`.t ferlStatfk li Ca orn for�Con}rac}or's License is hereby claimed
by undersigned: as owner PSI-, statement filed ❑
Undersigned attests that his State o{ Cesifofnia Contractor's. an _
is in full force end effect and properly o`r'ies }U�(p cal n��
San Jose City Business License # J
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner so as to 'violate the workmen's compensation laws of California.
OWNER RIdNRRD P FL-fi`/Lt=f2--
ADDRESS__l l�l �V Sl/])c n/ Lot No.
USE OF BUILDING
Signed.✓21�,ot..-21:�GGL1L{i2G�.�.1'.......��`�-'='�
280-20 ; - V
1185 Gardenside lane flayer
Type of B.T.U. Remarks (Check V(
Appliance No. Input New Replace Relocate
Gas Ranges
Wall Heaters
Boilers (Steam)
Boilers )Water)
Blower Furnaces
Suspended Units
Clof_6s DryCs
/ FEES _
Appliance Fee
Flues/Vents Fee
Flue/Venf Hood/Ducts Fee
Hood/Duct Gas Piping Fee
Condensate Drain Cond. Drain
Permit Fee
TOTAL FEE
INSPECTION RECORD
Ducts Underfloor
Ducts Complete
Flues in Wall
Flues Complete
Appliances/Mist. ;,2�d-�j
No. Gas Lines Outlets Sizelk-
Tested and Approved ,p 1a 7j ' �-I