5998 (2) 7569 Peach Blossom Dr. Buil /"
Noting Requireddif Confird O
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL 7�PERMIT
Date........../..2.-V.- -....._---------- 197/Permit No.........."
The undersigned hereby makes application to the Plumbing Inspector of the City of Sen Jose
fore permit to ins}all +he mechanical%orkglii}ed on the reverse side,
Exemption from requirement^for $tete of'Ceifornia for Contractor's License is hereby claimed
by undersigned: O as owner ❑ statement filed
Undersigned attests that. his State of California Contractor'sr's License
is in full force and effect and properly authorizes=This application'./ p�
_ San Jose City Business License # 0��(�i/ �(�/y/ f9
I certify that in the performance of the work for which this permit is'issued I shall not employ
any parson in any'Mar sner so as to violate the workmen's compensation laws of California.
OWNER LP n 2 /
ADDRESS (Z G /� No.
USE OF 'BUILDING BSc
Signed. _..--------- ' -
280-20.; �Q
7568 Peach Blossom Dr. Bugles Plumbing
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