21535 1190 ffiUPPELL PLACE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date-----------`:7/24--------------------- 1916 Permit No-------p .....--..----
The undersigned hereby s a f rrib' g for of fhe City of San Jose
fore permit to ins}all plu b� a s 1 reverse side.
Exemption from requirement f r Stale of California or Contractor's License is hereby claimed
by undersigned: as owner ❑ �4d)
to ile
Undersigned attests that his State of California is in full force and effect and properly authorizes this .
San Jose Ci}y Business License # 4i' + 13
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 n
Lot No.
ADDRESS )
sQao 2
USE OF BUILDING-
280-30
UILDING 280-30(9-13) Signed ------
1190 RUPPFLL PLACE CENTRA-T, SERVICE CO. INC.
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