10740 1194 RUPPELL PLACE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date.--------._`x/2`14.....--------- . ........ 19--6. Permit No.-...------IQ-.7. Q...--`---.....---
The undersigned herebyekes application to the Plumbing Ins ctor of the City of San Jose
for a permit +o install the a n' I o n r se
Exemption from requiremen a ais on Factor's License is hereby claimed
by undersigned: as wrier ❑ statement filed ❑ _
Undersigned attests the+ his State of Ca$Q O77
lif nira f n /J
is in full force and effect and properly author' s
San Jose City Business License 5/
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 the workmen's compensation laws of California.
OWNER " "_s4Q
ADDRESS Wk<k " r C Lot No. IP
USE OF BUILDING-
Signed
UILDING //�� ����``"" Awl;
Signed----(� d�- fviu-C�:�- .. ..
280.20 (6731
1194 RUPPELL PLACE CENTRAL
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