10207 (2) 3,9"2_ST�T,LTI�TG MoAb
Building Permit•Confirmed ❑
Not Required []��
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
�6. .. 19.7 ..... Permit No. _ .J
Date.._----....�.�.. .. . ....... ............. . ... ................ ---------
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install tha'7ch)�icat)jbr .liste���re�jide.
Exemption from regyGepeptt iaat- oF'Cal ifo is r Can}rector's License is hereby claimed
by undersigned: /as owner ❑ statement filed ❑�_
Undersigned attests that his State of California Contractor's J!Zans'e/# ���
is in full force and 'effect acid properly"authorizes .As/ppplic ofrw
San Jose City Business License # 9-' � 4
I certify that in tha performance oe work for which } is permit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNERGa
ADDRESS �� S / Lot No.
USE OF 'BUILDING
Signed-----...?f[«-.//!<—!< li�L2. v/G -----------
280-20 (9-73)
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