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Building Permit Confirmed/
Not Required ❑
CITY OF SAN JOSE BUILDING. DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
t .33.... -
Date---- ..111�y- .._1,5.._..- 1977 Permit No................_....
The undersigned hereby makes application to the Plumbing Insip gtar of the City of San Jose
fora permit to install t X,�.rc natal or li o T rerts/��e/
Esemplion from re�iri(Poe r } oromrrac}or's License is hereby claimed
by undersigned: s owner statement filed ❑
Undersigned attests that his p5}a1"e�of. U4..,herornia��onffec or se_#
is in full force and effect and r� a k/e/glhor/i�L }'llV.! m
San Jose City Business License
I certify that i performance of the work for which this permit is issued Cl shall ploy
any person in any manna so es to violate the orkcom ansation laws of alifor
OWNER C)
ADDRESS
USE OF BUILDING
Signed.... ... .... .. - .. - C— -----------
280-404N
.�-280-404N
1142 DERBYSHIRE OWNER
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