21535 1214 R77PPELLPLACE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date...._ -----' - -.`f----------- ------ -- 197.x.. Permit No.------- lS 3S! .
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---- ---- ----
unclersigned her akes c fha�2lurgf+iny Injyecfpr of the City of San Jose
for a permit to install um pi �S Iii ajyfljgyfrerse side.
Exemption from requiremen r State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed
Undersigned attests that his State of C i nfractor'
is in full force and effect and properly
aut eppic
San Jose City Business License
I certify that in the performance of the work 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 �,CCn7EL(—
rSLT nn FLL L, Lot No. 23
�Z) ADDRESS 1214 K
USE OF BUILDING _,
280-3019-731 , Signed..-- �4/LUILL(..a3 CQ-¢ rrY G.........
1214 RTTPPFT I PLACE CENTRAL
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