21535 1182 RUPPELL PLACE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date----------- Lt-------------------------. 197/.-- Permit No......fP .3S. ---------------
The undersigned hera6 es a 4' n a PI i9 In or of fhe city of Sen Jose
for a permit fo insfall pl� a ist d 'everse side.
Exemption from requ e o State of ali or w or Contractors License is hereby claimed
by undersigned: .4 owner ❑ statement filed ❑ / 7/ 3 J-
Undersigned attests that his State of California ac}or a J
is in full force and effect and properly authorizecati
San Jose City Business License # 86
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any mannersoas to violate the workmen's compensation laws of California.
OWNER
ADDRESS Z y�C- Lot No. /✓
J 48'b
USE OF BUILDING
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