13438 (2) 1330, F'10We Y� t- Building Permit Confirmed ❑
7 �' 0 J, � Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR ECHANICAL PERMIT
/ ;.2. ......_.....__............ 19-Permit No.....�.3 F
Date_. ..�.. .. . ...J.Q... ..... ..---
The undersigned herebyakap�licery 4 an�,lurn mg Inspector of the City of Sen Jose
for a permit to install t en al wor sta on Iw re arse side.
Exemption from re tiiremen for State of California for Contractor's License is hereby claimed
by undersigned: as owner/c' stvrtfa�fi d. G!
Undersigned attests that his State oT Ca ifornie C n}re Licansaf/7�^
is in full force and effect and properly authorises chis application.
San Jose City Business License # 4-7-6 t ')—C.9
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 workmen's compensation laws of California.
OWNER
ADDRESS Lot No.
USE OF BUILDING // 101.
Signed
:i':1�? lrrr!G[Sf�
280-404n
TR4n Fl numr rt . Atlas Heati_na & Ventilatin
Type of B.T.U. Remarks (Check V)
Appliance No. Input New Replace FRelocaft
Gas Ranges
Wall Heaters
Boilers (Steam)
Boilers (Water)
Blower Furnaces
Suspended Units
Clothes Dryers
FEES
Appliance Fee
misc. Flues/Vents Fee
Flue/Vent Hood/Ducts Fee
Hood/Duct Gas Piping Fee
Condensate Drain Cond. Drain
Permit Fee (9 n
TOTAL FEE (�
INSPECTION RECORD
Ducts Underfloor/—A,/,4 s� C .oY/
Ducts Complete
Flues in Wall
Flues Complete
Appliances/Mist.
No. Gas Lines Outlets Size
Tested and Approved