11567 (2) 1164 P(5T T TK=LL C15URT
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATIIOpN,, FOR MECHANICAL PERMIT
Date------------_...............G..-../.......... 19--76 Permit No.----11.,5-42............ ........
The undersigned heves epplie Plum bin Inspec}yr�oF the City of San Jose
fora permit to install t m t v id //
Exemption from ra� }aT ai n a f o ac z License is hereby claimed
by undersigned: owner ❑ statement filed ❑
Undersigned attests that his State of CaAl ria Contractor's License # -"R '0-5-16
in full force and effect and properly author' his a ion!
San Jose City Business License #
I certify that in the performance of the work for w is this permit s issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER —9 L' 06— ce
ADDRESS
o t� `�o.0 r r76cc Lot No. /
// L cT
USE OF BUILDING�'P a '
A & -- VALLEY PLIM46lNG
Signed. .. -------------- ........
... -' - - --
280-30 F, 0. BOX 524 — SA14TA CLARA, CALIF
1104 ROLLINGDELL COURT A & J VALLEY PLUMBING
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