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Tract No. Lot No. /`+l
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
:Date /0%3167 19_ Permit No. S S�Zr3,6,1✓
Application is hereby mae fora permit to Ru d
a 2_story, Type— Ka-5 Building Use ZoneOQ fB6
at 1463 S�e.� o,r � Occupancy_Z:—
to be occupied only Parking Space 2
in accordance with Plans, $ ecifications and��p ars ledrew-,hPFire'Sprinkler
Estimated Value of Improveme $
Exemption from requirement for Stat. i rnia f n1 elor' is s reby.claimcd by undersigned:
as owner ❑ statement filed ❑ pp
Undersigned attests that his State of California Contractor's License
is in full force and affect and properly authorises thapplication.
San Jose City Business License # -i0.f�is� '
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. -
Own noc *S C. Address //// 7S� Sa� SoSe
B _. Address
I
99/5-W01-1.081 --1
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