10740 1214 RUPPELL PLACE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date........ -/719 ..........._.------- 191.1!, Permit No.--------- O.7. V.-- --- -----
The undersigned hereby kes application to the Plumbing Inspector of the City of San Jose
for a permit to install the ec ni I ihj/*evjrt i
Exemption from req u' a a e e' f o ra rs License is hereby claimed
by undersigned: as ner ❑ statement filed ❑ _
Undersigned attests that his S ate of California Op�trac)or s License # 7/� '�
is in full force and effect and properly authorise�st tl� )ets�cation ��
San Jose City Business License # T /,�6
I certify that in the performance of the work for which this permit is issued 14 all not employ
any person in any manner so as to violate the workmen's compensation laws of California.
N p OWNER
ADDRESS U-11-4 Lot No. 2 3
USE OF BUILDING 2°Q
Signed...np{7�a(�P/WLCQCD.� 9KC.
28020 (6-73)
1214 RTTPPFLL PLACE CENTRAL
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