NO PERMIT NUMBER (3)6772 JOHNf DRIVE
Building Permit Confirmed.Q�
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION
� FOR MECHANICAL PERMIT
Date . � Z` .. /.. 117.7 Permit No............. ----- .............. - ----
The undersigned hereby makes application t the plumbingInspectorof the City of San Jose
for a permit to install the/ <%afni`�o/%/dsdloJr�}is�erse/ij
Exemption from requirement for Sfate df California for Contrac}or's License is hereby claimed
by undersigned: 6i owner ❑� statement filed ❑ /
Undersigned attests that his State of California Con tri cfo� s�kf'ben1se-[/6 -15—
is in full force and effect and properly aut oris ihil�lfca i n,�J�-�j
San Jose City Business License # l/
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any mann so as to violafe }he workm n's nsation laws. 10, of r•;iiornie.
�
OWNER 1- _/[CJ
ADDRESS
USE OF
Lot No.
a
Signed ........ .... V-_.
—lfVk '
280-4o4n
r77' .1/1HNd IIRT\/F
Type of B.T.U. 11 Remarks (Check V)
Appliance No. Input 11 New I ReDlacel Relocatr
Gas Ranges
Wall Heaters
Boilers )Steam)
Boilers )Wafer)
Blower Furnaces
Suspended Units
iance Fee
Hood/Duct I Gas Piping Fee
Drain
Permit Fee iC
TOTAL FEE
INSPECTION RECORD
Ducts Underfloor
Ducts
Flues in Wall /
Flues Complete
Appliances/Misc.
No. Gas Lines Outlets
Tested and