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Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date rf��0 19/, Perm No. Sy7
Application is here made for a permit o
a_I story,
�./Ty I 9 Use Zone
at Y OccupancyJ_
to be occupied only as -,q yii Parking Space L
in accordance with fans, Specifica+ions and Plot-plan filed herewith. Fire Sprinkler
Estimated Value o emenW, ,6
Exemption from r e for St� ra is License is hereby claimed by undersigned:
as owner ❑ statement fQ /p
Undersigned aftests that his State of California Contractor's License #
is in full force and effect and properly authorizes this application.
San Jose City Business License # `�'— /OJ ��
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 y 45r oc Address ��79
By Address
99/5-W01-I"OAL w,Oi
(20 �PZ -
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