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21167 (2)66199 NYFWN1Sl'UKI UK PHONE: 2]]-4581 Building Permit Confirmed [a Not Required CITY OF SAN JOSE BUILDING DEPARTMENT APPLICATION FOR MECHANICAL PERMIT Date......................51'..179 19........ Permit No.._......_Z-1 6.7............. 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 Lice: areby claimed by undersigned: as owner ❑ statement filed 7 Undersigned attests that his State of California Contractor's License # rT / :�, 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 person in any manner so as to violate the workmen's compensation laws of California. OWNER Q 0L d ADDRESS 0 'F'�p i`f y%NN/SP© ice USE OF BUILDING_ -/- - / Sign--. -------- .--................ 280-404N 8049 HYANNTSPORT DR A & H HTG Type of B.T.U. Remarks )Check V) Appliance No. Input New Replace Relocate Gas Ranges Wall Heafers Boilers (Sfeam) Boilers (Water) Blower Furnaces Suspended Units Clothes Dryers FEES Appliance Fee . D O misc.ee Flue/Vent Hood/Ducfs Fee Hocd/Duct- Gas Piping Fee Condensate Drain Cond. Drain Permif Fee TOTAL FEE INSPECTION RECORD Ducts Underfloor Ducts Complete Flues in Wall Flues Complete Appliances/Misc; No. Gas Lines Outlets Size Tested and Approved