21535 1210 RUPPELL PLACE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
L '
Date ...5 -4------------------------ 19�-�-.- Permit No. orl.�.S. ••� ........ -'
The undersigned herby make ppIicafion to the Plumbing Inspector of the City of San Jose
for a permit }o install plumbin its r s is 4 e arse side.
Exemption from requireme t or } x Licenso is hereby claimed
by undersigned: a ow r ❑ statement filed ❑ 7
Undersigned attests that his State of California Contractor's License # /7, 3 /
is in full force and effect and properly authorixes liiccatio9y�
San Jose City Business License # R�b'�`"�oO/�
I certify that in the performance of the or(-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 Gn ,j C— .L �1
Imo'`' 1 Z 10 Q�6 L.C.. PL, Lot No. —LZ I�
948 ADDRESS
USE OF BUILDING FP
28030(9-73) Signed .......
1210 RUPPFLL, PLACE CENTRAL
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