8983 11' 4 Obsiditn Court
Building Permit Confirmed (4r
Not Required ❑
CITY OF-SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date..............12-3-75------ -
19------- Permit No.................0....C.. ../....------
The undersigned herebV;akes application to the Plumbing Inspector of the City of San Jose
for a permit to install the mochenic`el work liite'd)on'Ihe re.e'rse side
d omen' l:� / . y"t"
Exemption from requirementor-Sfaterof CaliformaOfodConirector's License is hereby claimed
by undersigned: 'as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License # 110828
is in full force and effect and properly authoriies)}his-appliXry.�,,//��
San Jose City Business License # ���46-00069'/�///� �
I certify that in the performance of the wo`rVfor which this permit is issued I shall not employ
any person in any manner so as to violate the workman's compensation laws of California.
OWNER Ponderosa Homes
ADDRESS 7724 Obsidian Ct. Lot N012
USE OF BUILDING_.R 9c;
$ Signed -----------------....----------
280-20 I6 73 iCARLOS SHEET b.1ETAL WORKS, INC,
779 OLD COUNTY ROAD Sari czi s/m
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