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Hazardous Mater San Jose Fire Department <br /> Ah Bureau of Fire Prevention <br /> SAN Storage System NRW Four N.Second St.Ste.I ioo <br /> San Jose.CA 95113-1305 <br /> CAMAL OF SILICON VALLEY Phone:(40a)2T74-659 <br /> Associated Building Folder(Permit n,A FolderPermd# <br /> WW, 7, <br /> Businpss Name: ?Fhet1V%e-61-4-4- Date: H 1 7-) 1 C)-2- <br /> Address: 350 Rtlie-Of San Jose,CA,Zip: 01-51SL <br /> Nearest Cross Street: �ino�d Contact Person/Tide: AripI-T&Mloi- Ph:(ft 6Z3 -3244 <br /> Business Name: J@C�P%c bt— <br /> Mailing Address: ?10 160*� 5095',Afn 21,000 City: -�Aftqp 0111 State: CA Zip: 1;14"1, <br /> ContactPerson; P(10%311,JV0- Tide: <br /> Phone:Li7-!J of C9LT-J 20% 1110� e-mail address: <br /> Business Name: Me- <br /> Mailing Address: 3qOq V&rk-R9 6emiose,-eA-.-Bp: CA q9510 <br /> ContactPerson: tnPfV- 0160001% Title: 1AAA,1A 0L?&eAA1rd%X%.w— <br /> Phone:Ll�j I'll --1-)01 or e-mail address: <br /> *San Jose City Business License Numbec Expiralibn 9 L I <br /> 'Worker's Compensation Number. -51361SO032,UZ ExpirationDate. (0 /'At /03- <br /> 'State Contractors License Number and Type: 55q C)02 Expiration Date. 07 /-3 1 /j2LL_ <br /> *If exemp�then contractofs information sheet must be submitted " application. <br /> WORK PROPOSED (select one) TYPE OF PROJECTISYSTEM:(Select One) <br /> a cicsure E]Facility Partial Closure Hazard Compressed Gas/Ce/ogenic System El Variance <br /> []Repair El Facility Full Closure C1 Inert Compressed Gas System Battery System <br /> El New Installation C]Alteration Other Hazardous Material System(NOS) Metal FinishinglPlating Une <br /> 0 Removal 0 Temporary Clo5uw,-u,5ir Aboveground TanklPiping System(liquid) Facility Closure <br /> Note. Underground TanklPiping SMem or VarianceT MUSt 0S.Linderground Tank[Pipmg System(liquid) L.P.G�.Tank Piping System <br /> have addiflona�applicatons attached to this form. <br /> SYSTEM COMPONENTS 'PRIMARY CONTAINER. 7'SECONDARY:'CONTAINMENT <br /> H.az�rdous-Materials:Stored --�Size(Volume, Constructi�)n Si7e,(Volbrine, <br /> Pipe Dia ;,.Atc.) Material,: <br /> 4;awl <br /> 2 <br /> 3 <br /> 4 <br /> 6 <br /> Attention Contractor: <br /> This permit is being issued pursuant to the requirements specified on the attached San Jose Fire 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 permit 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 /> APPUCAN'rS NAME JPlease Print) TITLE(Please Print) APPUCANrS SIGNA TURE DATE <br /> irnpnagf- I 9�-Iu -- 1 <br /> FIRE DEPARTMENT USE: <br /> Date Arov 6 B Inspectoi's Comments <br /> ove" <br /> Plans Revievmd 1 11 1 <br /> Primary Containment —t-1— <br /> Secondary Containment I I <br /> -T— <br /> Monitoring System <br /> Other: <br /> Final Inspection i W4114 -fho-- I-LA-7/03 <br /> r�Nc.240-143�R�1 F02� Copies:WHITE-PermA File PINK-Appficanl HARDC�IpyJobSite <br />