21535 1202' MTPPELL PLACE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
- ............... 197(e.. Permit No. 21's-2--s-- .. .....
Date-- ------`-/Z
The undersigned hereby ma ��is�iQ n�� h Plumbin Inspector of fha City of San Jose
Fore permit to install plumbi� s e t r ono side.
Exemption from requirement for 11jj�e'ofl iforni f o ors License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ / .7i f,37
Undersigned attests that his State of California ontracior's License
is in full force and effect and properly authorizes f eiioyg n/w/
San Jose City Business License # ag 6'�,i
I certify that in the performance of the work for which this permit is issueerl shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER /J �/
..Q-Q �L
�.4�() ADDRESS 12c: Z 4'-�'a Lot No. Zo
'
USE OF BUILDING--/C-
280-30
UILDING -/C-
280-30(9-13) Signed._.C"'-`------ "r_-"�-=- Q'+-^''f.Z ' .........
1202 RUPPELI, PI,ACF, CENTRAL
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