12250ZioS �?orLYI�nnL> COURT -
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
/0 ...... 19..�%6 Permit No.....l.�J�
Date ----------------...------ ' -- --------------------
The under,,' under,,' nod h 5 m kei p' ti n to A Ib bin sp)ector of the City of San Jose
fore permit #o insf i#�mi a br d i v si e.
Exemption frodzw4t re or a of a ifornia for C actor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of Cha lifornia Contractor's License
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is in full force and effect and properly a/u)n chis ppl' e{�
a3''5�/
San Jose City Business License #' /
I certify that in theperformance of the work for which chis permit is issuE�l shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER T 1- C o6nNSZ' .
ADDRESS
USE OF
280-30
)ang RnT,T,TNRT)FT.T, COTTRT
Lot No.
A & 1 VALLEY PLUi.1BING
Signed-------- ---------------------- --------- -----
P, O'ARCTX VATTFv1F1TA CLARA. CALIF.
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