21535 1206''RU15PELL PLACE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date......... .. 1976--- Permit No.----------125 ------------
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumIs f' u s /oy�p�� list �qry a .a side.
Esemption from require a 'rC/0 Is"�u/". r Q/ o mense is hereby claimed
by undersigned: as nar ❑ statement filed ❑
Undersigned attests that his State of Califor 'CoCoo tractor's License # 71,J ' 7
is in full force and effect and properly authorize pli h.. . /(/.l�
San Jose City Business License #
I certify that in the performance of the work for which this permit is iss ed I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNERa36�—L-
0 ADDRESS �2�1n �/ /L' Lot No. 'Z
USE OF BUILDING
/ Signed ..._L.... a �D 3rfZC
280-30(9-73J I ...---.......-----......--------......----....
1206 RIJPPFT,L PLACE CFNTRAT,
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