10740 1198 RUPPELL PLACE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
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Date...........j ----------- ................ 197.4?. Permit No.--------/�--//07W-----------------
The undersigned hereby makes is fin o�e PI tubing In patter the City of San Jose
for a permit to install fhe mach 'c rev se�
Exemption from req uiramenf or Sfa of Ca if ni o C ra o icense is hereby claimed
by undersigned: as owner ❑ statement tiled ❑
Undersigned attests that his State of Californi ontractor's License # / 7/J .37
is in full force and effect and properly authorizes ht �Ilcatiof /�/ �
San Jose City Business License # /
1 certify that in "a performance of the work for which this permit is issue I-shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER _Aj_,J�
ADDRESS I I 19
Lot No. 9
so USE OF BUILDING
Signed.no7tuwUR CD. -91LC----....
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280-20 Ib-73)
119 RUPPELL PLACE CENTRAL
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