11545 (2) 1104 ROLLINGDELL COURT -1
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION
p tFOR MECHANICAL PERMIT
Date-----.._..---__............ ........Q..-... 19_.)..4. Permit No.-.../ L._ -----------------
j
The undersigned haxeby makes application to the Plumbing for of the City of San Jose
fora permit to in fh m �_�`J9ik
Exemption fr nye ��ffor�9} of ifa�fof'Cofr's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ c/ /
Undersigned attests the his State of ifornia Contractor's License # Ai 7 7 b
is in full force and effect and properly a a£ee this at'o
San Jose City Business License # y� 1 d V ��
I certify that in the performance of the work for which this permit'is issued I shall not employ
any person in any Wanner so as to violate therworkmen's compensation laws.of California.
OWNER f�—✓r��/(�
ADDRESS Lot No.
USE OF BUILDING �)/
Signed.W .- - .� L /.C,------ -------
280-20 (9-73) /�
1104 ROLLINGDELL COURT STC0,HTG'4&A/C INC_.__
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