22141 1158 ELMSFORD � PHONE: 27]-4581 ��,�,,�/ J
Building Parmi} Confirmed� //
Not Requirad �I(] /
CITY OF SAN JOSE BUILDING DEPARTMENT
� APPLICATION FOR MECHANICAL PERMIT
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IDafe..._ ._.........�.. .��..._.......... 19.7..1 Pormif No...._...._.................. . ........... !
The undersignad her�� maLes�eppicef'on fo fha lumbing Inspeclor of }ha.Ci4y of Sen Jose
Lfi i
� for e permit fo insfall/i6� mp a ¢/�wor"'lis ed of� e raversa sida,
Ezemption (rom��q�rem��r }r�fe/Of C�iEo'rdf�or Conira<tols Li<anse is hereby claimed
by undersigned: r es owner ❑ s}e}amen} (iled ❑
Underugned ei}esh fhe} his Slafe `of`Celifomia C fre<fars icenae—# � �f�
is in full Forca and eifect and properly eufhori:es } �jp�ca '��
' $an Jose Cify Businas� Lice�se #� v a 3.�i S
I <ar}ify fhat in.ihe'par(ormence o( fhe work for which ihis parmit is iseued I shell nof amploy
' any perwn in any manner so es fo v/�io.lafe the workman's compensefion laws of California. �
OWNER_y�S��.I�I�J l�
ADDRESS � � FO� Lot No.
USE OF BUILDING �5� ��C�
' Signed... .. . ..._ . ��'..`� . ._... ..........` -....
��1�� ���•280-404N
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