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OF Hazardous Materials San Jose Fre Department <br /> � <br /> T' Storage stem Per Bureau of Fre Prevention <br /> SI�l V7�7 JQS StSystem y Four N.Second St,St,11 Be <br /> GPRAL Ci 9DLCN <br /> San Jose.CA 951131305 <br /> Phone:(408)2T7-4659 <br /> Associated Building Folder(Permit#F n FoldeoPem9t#.X0OP <br /> '� 44?QJEG3/EACI[k,TY,:[flCAilO v ,xPW' '-�..'l,.A �•�'sm�r�yy.c ,:^:;,. _ _ <br /> Business Name: Date: If _/ 21 / OZ _ <br /> Address: 35gb HIRCA, A~n - San Jose,CA,ZIp: gnsi. <br /> Nearest CrossStreet 50tHl A.rc..ve ContactPersorurl-ise: Mwh TAwIPr Ph: <br /> Business Name' yfc�p,,Ot,6-- <br /> MailirgAndress: 4o 0or S'0451 Am 3t 000 City. .Origpn State: C4 Zip: 46158� <br /> contactPerson: Anoy'fp'dE A- Tine: (rMRMnKrrfat MAn%L0. <br /> Phone: R( S) - (L6 or 9( 2S 1 90\ - n5ol email address: <br /> Business Name: 105C <br /> Mailing Address: 3904%rb R0 serrJds r,ap: (3rawuw CA 4`1570 <br /> Contact Person: (no^ lneof" Title: 31.1"ret/4..sn*RTuL <br /> Phone:1�O14N,7 --1-)01 Or U _- email address: r�G <br /> 'San Jose City Business Uberse Number' YT4D W b Expiration Date: <br /> 'Workers Compensation Number: 58AISOD3202 Expiration Date: (o /31 /CS <br /> *State Contractors license Number and Type: slag 002 Expiration Date:QZ/-bL/ — <br /> 9f exempt,then contractors mornabon sheet must be submitted with application. <br /> WORK PROPOSED (Selrrct one) TYPE OF PROJECTISYSTEM:(Select One) <br /> ■closure ❑Facility Partial Closure ❑Hazard Compressed Gas/Cryugemc System ❑variance <br /> ❑Repair ❑Facility Full Closure ❑Inert Cpmpressed Gas System ❑Batery System <br /> ❑New Installation ❑Alteration ❑Other Hammus Material System(NOS) ❑Metal FinishkKyPlating Line <br /> O Removal Temporary Clv&v -0$f ❑AbovegrourM Tank/Piping System(liquid) ❑Facitily Closure <br /> Rotes Undaymunli Tank/n,,system or v....must ®.Underground Tank/Piping System(liquid) ❑L.P.G.Tank Piping System <br /> have sdditlonal applipxtlons aeached ki INs form. <br /> SYSTEWbOMOONEtifTS - :PRIMARY:CONTAINER: - SECONFJtilRY3'C0t4TA1NMENT�.-' <br /> Mazatdaus feQa'is\S ed Cumin ban Majoral, "'b",(volume, - Cnnstucton' Srze(Vdr#ne.i- <br /> Pipe Diam.,em.) Material Pi.'..`piyn;';etc . <br /> 1 $ffee .ipw4 <br /> Y sin <br /> 3 <br /> 4 <br /> _ 5 <br /> Attention Contractor: <br /> This permit is being issued pursuant to the requirements specified on the attached San Jose Fre Department Plan Check. It is your <br /> responsibility to post this document conspicuously at the job site prior to commencing work. You are to have an approved set of plans and <br /> San Jose Fire Department Plan Check available at the job site. You must contact our office to schedule all required inspections at least <br /> 48 hours in advance. This perm is valid for 180 days from date issued. The project must be completed by this date,unless prior written <br /> approval for extension is given by the San Jose Fire Department. <br /> "PDMS hl J(Plsa¢a Print) NTSIGNTiRE DAE <br /> i <br /> FIRE DEPARTMENT USE: <br /> Date V20 B Plans Reviewed �/I f / OZ Inspectors Cornmorlis <br /> Primary Containment _/ /_ <br /> Secondary Conlainment <br /> Monitoring System /�l / OL on-piny <br /> Other: <br /> r / / <br /> Final Inspection <br /> W <br /> F—Ro.xaaua rne..1.21 Cceo WlArME ermd File PINK-4p6mrit 1 RDCopyJoe Site <br />