12117 (2) 830 AtI.PLIN AVENUE
A Building Permit Confirmed ❑
vt Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION. FOR MECHANICAL PERMIT
Date- -------- ........................_/-161- 19---24 Permit No.._. OZ11 .---------------
The undersigned hereby makes,applisatioh.}o the,Plumbing�lnspec}or of the City of San Jose
' fora permit to install the me�ham`iceli�workVlisted 1h�r sv jn ,,de.
E.emp}ion from requiremeni�fordSlafe rof California for Contractor's License is hereby claimed
by undersigned: , las owner'❑ 1 statement filed ❑ .�
Undersigned attests .that his State of Celifornia,Con}ractor's License # C55` ,�'U /
is in full,force and effect and properly aulhorixes"fhis�applicaiiori
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 ;o as _}oqviola a f workmen's compensation laws of California.
OWNER �A��/�{
���9� Lot No.
ADDRESS ,
USE OF BUILDING ✓j�
L.Q..�>
280-20
830 BETLIN AVENUE TRANE
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