21650 /712 gvAT EAWOOD DRIVE PN ONE:,27Y-45B1
Building Permit Confirmed}�
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date.....oI//07. / 19�/... Permit No._ .�..�50---....-------
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install the mechanical work listed on the reverse side.
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner (3 statement filed ❑ n
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes this application.
San Jose City Business License # Y'?_ Qcaa` a li
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.
OWNERI�UCE /l/OEL
ADDRESS 75/2 HER 7f& kO0/) D 2 Lot`No.
USE OF BUILDING FAM/L' Ct7M ' . 1
Signed..... .. .�UA�.W....fl - ..... ... . -`--------
29e-4N
7512 HEATHERWOOD DRIVE BIORN CONST.CO.
Type of B.T.U. Remarks (Check V)
Appliance No. Input New Replace Relocate
Gas Ranges
Wall Heaters
Boilers ISteam)
Boilers (Water)
Blower Furnaces
Suspended Units
Clothes Dryers
FEES
Appliance Fee
Flues/Vents Fee
Flue/Vent Hood/Ducts F-
-Hood/Duct Gas Piping Fae
ondensate Drain Cond. Drain
Permit Fee
TOTAL FEE
INSPECTION RECORD
Ducts Underfloor
Ducts Complete
Flues in Wall
Flues Complete
. Appliances/Mist.
No. Gas Lines__Outlets J— _ Size _
Tested and Approved*