9281 1390_PR1M0SEFWA'Y1
Building Permit Confirmed ❑___
V VV K7 Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FORSMECHANICAL PERMIT
Da+e..�2'... �.__.........-.........--- '191 Permit No.._--......�Zap/
The undersigned herebys makes application,,#o the Plumbing Inspector of the City of San Jose
fora permit to install the mecha nicallwd'rk,lis}ad Wtho.ieverse'side.
Exemption from requiremenYfor Sta{e of�Celifornia%for-Con}ra c}or's License is hereby claimed
by undersigned: as owner E statement filed E i
Undersigned attests that his State of CalifornM ia(Contractor's License.#= �-
is in full force and effect and properly ppcatioy
au}hoiisei-#hiiss alin�7�`L�p�
San Jose City Business License #' .-�L' cation.
jl
I certify that in the performance of {he work for which this permit is issued I shall not employ
any person in any manna so as }o vi late the workman's compensation laws of California.
OWNER _��� �. �'—
ADDRESS�Y�/'�`� L!% Lot No.
USE OF BUILDING .4 Z� /
Signed Lr� -----
280-20 (9-v JT.
J.440 PRTMR(lAFRWAYAY
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