16684 (2) 1134 S,: . Sfell ng Rd ,
Building Permit Confirmed ❑
No} Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION
Q FOR MECHANICAL PERMIT
Date................................ a-8....... 19T? Permit No.........L .. .g....l - .........
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install the mechanicalrwor lis addn I- � side-
f16 �
LSExempfion from requirementa .1 � rector's License is hereby claimed
by undersigned: as ownl" ❑ statement filed ❑ _ _` '
Undersigned attests that his State of California Cony�radJors Lp�hso 0 ^Iv
is in full force and affect and properly authorizes ih^isi^fti'Vtion..7�(/
San Jose City Business License # 419—llV"/Q(12
I 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 -Ro�? &:Rm
ADDRESS 113y S . STC-Lu N l7 Lot No.
USE OF BUILDING__ SIoeoCE
Signed .-' - ---- .. ----------
1134 S. Stelling Rd. Valley Htg. 280-404n
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