19619 7399 Y20LY Yt3Gfj L� f3RY (\p P440"'Build�PeIt Confirmed ❑
V V Not Required [�
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date-----I..Q., 3 d..-. ....... 19........ Permit No........ G lr
The undersigned hereby ptekea}io�� umbing Inspe r of the City of San Jose
{ore permit to ins}ell the a w o A $
e a
Exemption from requi em 5 a i orn a or o c}or's License is hereby claimed
by undersigned: owner ❑ statement filed E]
Undersigned attests that his State of California C tr e. spm /
is in full force and effect and properly authorizes } s Brca}is �//
San Jose City Business License # � �
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 A. , 119-a t-
ADDRESS_Z✓ LLI ✓(� �lz� L �L- Lot No.
USE OF BUILDING � "'O/�J��P��JJ
7398 ROLLINGDELL DRIVE FOREV .
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