10564 (2) 7484 'KINGSBURY; PLACE
f Building Permit Confirmed ❑
it
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT.
APPLICATION FOR MECHANICAL 'PERMIT
Date. —4----------------- 197- .. Permit No-------Av lo.-�-------------------
The undersigned he makes' applica}ion_fo' the Pymging Inspector of the City of San Jose
for a permit t`o- li t e mZ.n! wor/kAsfAd�r }he reverse side.
1 Emmption from ra mremen} for S}et@ o{ California for Contractor's License is hereby'daimad
by undersigned: ( as owner ❑ statement filed ❑
Undersigned attests that his State of Ciliforni Contrac}or's.Licens- -7
is in full force and affect and properly a�fh�ori:es ihis e�pl�i{eatLon��
•San Jose City Business License #
. ' 1 certify that in the performance of the work for which this permit is issued 1 shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER I� Cn1 ECL
�Xp Lam', �
sg po ADDRESS 'd- 84 /"7�S 21 a cj //L Lot No. 7
USE OF BUILDING 2Fg ,
CSuts�[cu------- ----dale--A,, ,9f?l
Signed - ... ------- `---------------
280720 (6-73)
7,184 KINGSBURY PLACE CENTRAL SERVICE
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