16278 (2) 7574 WATERFORD DRIVE Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
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Date_..... . ...-..`....�........._............ ... .19.7--� Permrt No..... --
The undersigned hereby makes epplicatio to the Plumbing Inspector of the City of Sen Jose
for a permit }o install the mev rL(ciaj��t rer q o�tK�r�6ser ja,
Exemption from requirement forr)Stafe of alifornia for Contractor's License is hereby claimed
by undersigned: as owner &I statement filed 0
Undersigned attests that his Ste}e of California/Goniraclon'i 8icehie/.iF
is in full force and effect and properly authoriiestithis applisaranv s,(((���
San Jose City Business License #
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
wworkmen's compensation laws of California.
OWNER t .4Zey t!1• I[fA7�/ .S
ADDRESS -7S-74/
USE OF BUILDING
Signed...__ ........... .... ....
280-404n
7574 WATERFORD DRIVE OWNER
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