21535 1186 RVPPRLL PLACE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date------------- /�------------------------ 19710 Permit No.--------�fS— .------------------
The undersigned hereby m s a plica o t Plui b' An pe }oyeaf t City of $an Jose
for a permit #o install plum s �(�7 sf& side.
Exemption from requirem n# or ate of alifornia for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ �77
Undersigned attests that his State of Celi j��`ontra �r�17/
is in full force and effect and properly au#h as sap o
San Jose City Business License # 4-
I certify the+ 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 the workmen's compensation laws of California.
T � OWNER —U11l.-1Q— n
Y ADDRESS kxxb at ti= � PL, Lot No.at+= x-� OLi Lot No.
S0 USE OF BUILDING
�ithu(_�nri�ce � -- --
280-30(9-73) Signed .....---- -
---'--- ---- -9nc .........
1186 RIJPPFLL, PLACE CENTRAL SERVICE CO. INC.
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