3672 1162 Stafford
` Building Permit Confirmed ❑
G� Not Required i0
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date.// YCf�/i -�.1--_.. 19/.T. Permif No.------ 147 --...------
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install the mechanical worrk`listed"ort)}herrreverse side
H i�"n_'.;.'/y it o/' •"iii
Exemption from requirement%for.$fa}e of £Ii4orma rfor'Corilracfor's License is hereby claimed
by undersigned: as owner statement filed ❑
Undersigned attests that his State of California Contractor's License
is in full force and effect and properly authorize, eppli/ce}ion. G ..
San Jose City Business License # �
I certify that in the performance of the work for which this permit is issued I shall no+ employ
any person in any manner as to violate the workmen's compensation laws of California.
OWNER �D /fl17 /
ADDRESS /C� O� (�J�/� QR Lo+ No.
USE OF BUILDING/r t i , Q —
Signed.
280-20 (673)
1162 Stafford phillips
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