8835 (2) 7476 BollingerRo8id
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL rPPERMMIT
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The undersigned he by makes application to the Plumbing Inspector of the City of San Jose
for a permit to instal he c is w lishe yv�e'se side.
Exemption from 1 o t o i or /Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License $k �of '
is in full force and effect and properly `th ' es this ap I'cation
San Jose City Business License # Q C�CrJCJ � 0
I certify that in the performance t e o for w!iich thispermit is�iss d I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
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OWNER ��� z/�'=�
ADDRESS_�(p I25Oz-G IA" 6'1471' 210 Lo+ No.-
USE OF BUILDING
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Signed-- - rlZG2z -- - �� �.
280-20 (6-73)
7476 Bollinger Road County s/m
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