10740 1190 RUPPELL PLACE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date.---------.�/Z.f......_... .. 197 .. Permit No..........10..77. --
The undersigned hereb t ��ctor of the City of San Jose
for a permit to install }he ehanehh.n111l11 work listed on }he reverse sada.
Exemption from requirement for State of California �or�C.on}re for s License is hereby claimed
by undersigned: as owner ❑ //_�C�t. �`/ma y
Undersigned attests that his State of California on acto e s (��J"
is in full force and effect and properly authorizes this application.
San Jose City Business License # ¢( ^ (no) )3
1 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 the workmen's compensation laws of California.
OWNER
Sq�Q ADDRESS �l O �l�iG.�if D 0 0 �L , Lot No. /J
USE OF BUILDING '
Signed--- /Wfhn-- � -Lng-�?O-----n!?r ----
280-20 16-711
1190 RTJPPETT, PLACR CENTRAL
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