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Tract No. S Lot No. /0
CITY OF SAN JOSE BUILDING DEPARTMENT
APP (CATION FOR BUILDING PERMIT _
Date_ 9'1 D 19 -LZ Permit No.
Application is hereby made for a permit to `ae i /I/
a story, Type,T- Building Use Zone .Lri_ e
at —% ! .7_/!rly— S- — / Occupancy__
to be occupied/
ccupied only as ,d�/, Parking Space 2
in accordance with PI ms,'Sp ifications and Plot -plan filed herewith. Fire Sprinkler
Estimated Value of lmprove n s, t / q�
Exemption from requirement for t a alifornia ac e h9�ey claimed by undersigned:
as owner ❑ stat at filed /Q — 9 /
Undersigned attests that his State of California Contractor's License # /✓'�/ /
is in full force and effect and properly authorizes this applicefio .
San Jose City. Business License # 4 _ �C)
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. S
Owner ' Y' S oc 7rc. Address Z � 7� ,
By Address
99/S-W01-POBL WJ04
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N01103dSNI 10 G80033