10740 1182 RUPPELL PLACE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICA
L//.��P--77ERMIT
Date-- ---- W- --- - - Z4-
-----W- --./�. .2 4------------ 19.11, Permit No.-`---10-/---`-�- --------------
The undersignad hereby makes application to the Plumbing Inspec r of the Ci}y of Sen Jose
for a permit to install tha c ni al �J�� I' th ra ,d
Exemption from requir +- Vem,e f r'Mon
is License is hereby claimed
by undersigned: a owner ❑ statement filed ❑
Undersigned attests that his State of California C or's
is in-full force and effect and properly authorises }Iyfca
San Jose City Business License # f(e — 00//Z
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 nthe workmen's compensation laws of California.
OWNER 1Z
.S.{a"U ADDRESS tYZ Lot No. Jj,
USE OF BUILDING
ii Signed..----- (1!4^-----
280-20 (6-73)
1182 RUPPELT, PLACE CENTRAL
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