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Tract No. Lot No. �l)
CITY OF SAN JOSE BUILDING DEPA MENT
PLICATION FOR BUILDING PERMIT
Date D , 19&7 Permit No. 76
Application is here made for a `permit r
a_story, Typ C d ing Use Zone
at :m Occupancy
to be occupied only as 5o i-2. Parking Space Z
Fire Sprinkler
�n' io n Plan filed herewi#h.
P
in accordance with P/x Specificat ns a do#- Ip ::.� _
Estimated Valuen#s5taEzampiion from re�e t
r o /e�At=Xeraby cleimud by undersigned:
as owner statement filed El
Undersigned attests that his State of California Contractor's License # Z
is in full force and effect and properly authorizes }his application.�/
San Jose City Business License # u' /OS�e
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 r SJ 6G 11 1 h Address //yf �o /� wH 9 S J.
By Address
99/5-W01-1-08Z w,oj
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