5726 1150 Stafford dr
Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION F� MECHANICAL PLERMIIT/
Date..------_�.. (.�../_ ......--------..(19-/ Permit No.--------._..J .G..�fJ...._---
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install the mecheriicdl.work-listed_on the/reverse"side r�
�
,
Exemption from requireme 4r State of-California for Contractor's License is hereby claimed
by undersigned: as owner S statement filed ❑ /.
Undersigned attests that his State of California Co trabtor's Licensee
is in full force and effect and properly authorizes,this-`application.i
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 somas to violate the workmen's compensation laws of California.
OWNER Z1nn / 4-f- P pCYI/wZ
ADDRESS 115--,) > /-/-O4G� �i �i!�u` Lot No.
tl
USE OVBUILDINf �9/J
/ Signed---- --------
280-20 (9-73)
1150 Stafford davis
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