11545 (2) 1121 ROLLINGDELL COURT
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
�/.............._...... 19... .6 Permit No.�. . .....
Date-------...............�..1.. S -y�
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Tha undersigned here .�makes a lice f,iyn the Plumbing actor of the City of San Jose
for a permit to install T�rryeS n e or l!1 o t side.
Exemption from requiramma or a of or is for n�tractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ b
Undersigned attests the+ his State of CaliiS a ontrecfojjt' L
is in full force and effect and properly auih i� appJ�
Sen Jose City Business License # L/ iCJ Oj
1 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 workmen's compensation laws of California.
OWNER PV14-r^ A.4
ADDRESS/Z) � 4, ° -Ce- Lot No. 9
USE OF 'BUILDING �&4
Signed .-.4
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280-20 (9-13) >_--r-
1121 ROLLINGDELL COURT WESTCO 'INC.
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