10564 (2) 7522 KINGSBURY PLACE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR -MECHANICAL PERMIT
Date---- ------------- ......................... 19.2(4. Permit No.---/m- ...--------------
The undersigned he makes a lic tion to the Plumbing Ins ecfor of the City of San Jose
for a permit to insfall t m al os + ve i
Exemption from req amen f 1 o actor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of Calif
Qq��m Contractor's License 7
is in full Jose
and effect and properly aulhori t �Olic / T�
Sen Jose Ci#y Business License # �// C/.C(�
I certify that in the performance of the work for which this permit is issue I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER 1 6-/j 6 L(_
�as`cr
ADDRESS -7j-7j-z-Z /eicfJ �raKy �C Lot No. 3
J-490 �t J
USE OF BUILDING
r�-tAmf S22arrn �'n., Rnc
Signed.. t... -------- ------------------- ----------
280-20 (6-73)
7522 KINGSBURY PLACE CENTRAL SERVICE
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