10564 (2) 7.498 KINGSBURY PLACE
Building Permit Confirmed ❑
11 Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
'i APPLICATION FOR MECHANICAL PER'/MIT
Dai /o.s
ii The undersigned hereby meVas .�n,
li i th m ec+or of the City of San Jose
fora permit fo install qh m v 5-i
Exemption from re menS+a a of California for Co rector's License is hereby claimed
by undersigned: r ❑ statement filed ❑
Undersigned attests that his Sta}eof Cal rnis n}red s Lie e 7/J .f
is in full force and effect and properly au} ri s(lyus app
$an Jose City Business License # iD
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 workman's compensation laws of California.
OWNER 1tZ-Flo 5LL-
5-4$0' ADDRESS 749,9 (,s Qu/LLy 7 L Lot No. S
1 USE OF BUILDING / �j I q
Signed - /1IC �J • /� .....
28(I-20 (6-73)
V; 7498 KINGSBURY PLACE CENTRAL .SERVICE
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