21535 1194 RUPpELL Pan
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date z`/' ....... I .Z�.. ermi+ Ny.... � ------------------
The undersigned her s n ct of the City of Sen Jose
for a permit to ins}ell p -46. 4'R�res a�-nd//or pipes listed on the ravorse side.
Exemption from requirement or State of C lifornie for Contractor's License is hereby claimed
by undersigned: as owner o !{'od
Undersigned attests that his State of C❑ i 7 ntrAC'?L e Ta
is in full force and effect and properly authorizes this application.
San Jose City Business License # 46 "4901 ?
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.
Yc OWNER
S70D ADDRESS 119 4 �� LIY P�, Lot No.
USE OF BUILDING
280-30(8-13) Signed .....Lr. -s '-`-�''000.C,(1.1..Y/.'LG--------
1194 RUPPELL PLACE CENTRAL
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