16164 1614 JAMESTOWN DR Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL// PERM/ IT
Date...... ........_._........_------_........... 19....._. Permit No......../P1- .:/.. ---
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install tai>•mechanical�work7lii}ed�an the reverse side,
� A. A//r!/ Ov' .f �i
Exemption Gomlregmremeni for,State of Ca ifornia for Contractor's Licen ereby claimed
by undersigned f as owner ❑ d St.fomentfiled0��
Undersigned attests fhafjhis State of Ce�fomja Colt s_Li<on7e
is in full force and effect an�Arop'erly aufhor¢ � ' i pl Sti �
San Jose City Business Liceme%#
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 ;rj0viola}e the workmen's compensation laws of California.
OWNER I/J
ADDRESS
USE OF BUILDING nn��
Signed-A - ----_ .. L�/
280-404n
1r14 ,IAMFS TOWN f)R A & H HEATING & AC
Type of B.T.U. Remarks (Check V)
Appliance No. Input New Replace Relocate
Gas Ranges
Wall Hea4ers
Boilors (Steam(
Boilers (Water(
Blower Furnaces
Suspended Units
Clothe, Dryers
FEES
Appliance Fee
Fl..TfV nts Fee /--O
Flue/Veno Hood/Duc}s Fee
Hood/Duct Gas Piping Fee
Condensate Drain Cond. Drain
Permit Fee
TOTAL FEE
INSPECTION RECORD
Ducts Underfloor
Ducts Complete
Flues in Wall
Flues Complete
Appliances/Misc.
No. Gas Lines Outlets Size
Tested and Approved