31286875 Ald2rb�ri #29
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date ....... 7�t. a.....'.
Application is
to be occupied only
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in accordance with a ions a Plans,�p s, to I le
Estimated Va!ue of Im vem $.......... t.. ..... .....
It is hereby agreed that the requirements of the San Jose Building and Ordinances and all other
laws applicable to the construction, location, and use of buildings within the City of San Jose, will be com-
plied with.
I certify that in the performance of the work for which this permit is issued I shall not employ any per-
son in any manner so as to become subiect to the workmen's compensation laws of California.
... ............... Address ----- .................
t0ldte .t.r. a ............... �_ .
. Ad, dress. -- -- - .. Calif.--- .......
Form:eo.i t
Wheatley
RECORD OF INSPECTION
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