21875 J1� LyBG�1T l,b'Ul[1 PHONE: 277-4581
Building Permit Confirmed 4EIt '
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR ryMECHANICAL(�PERMIT .
Date.. (/L-y..._ O.-..-...---:........ 19.7.7 -Permit No...2-1?.�--�----------------
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install the mechanical work listed on the reverse side.
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as 0.ner�z statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes this application.
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. C/�LJI
OWNER c71e)AI S c/- . S—.4Yr7AIS
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ADDRESS `-'��c`/GTY ����- Lot No.
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USE OF BUILDING
//280-404N
911 LIBERTY COURT -- OWNER
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