10740 1210 RUPPELL PLACE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date........---.2471- .`.f........................ 197C-. Permi# No.-----------I,U..7.-7-U-----------.---
The under ' nad he by makes application }o fhe Plumbing Inspector of the City of San Jose
for a permit }o instal h c .ate on k�tay�rsa�ida.
Exemption from r o e elf rniak'ioe( +rector's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly Pt 1hi np ice}_ ion.
San Jose City Business License # �•�l/��/,'
I certify that in the performance of the work for w.hich 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
S ADDRESS 0 t Lot No. 'ZZ
USE OF BUILDING c_`-. /►
Signed. [lLC2CO.�_Yi1G__----
280-20 (6-73) -
1210 RUPPELL PLACE CENTRAT,
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