54768 p/a Yr I5BoAsr Lane / �¢�
Tract No. 1 S$ Lot No. / 7
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT 15*�
Date_ 3 a , 19 ,17. PGrmto. 5"g76 ,e
Application is here6y made for a permit to 19,11 ,
a story, Type )gY, Building Use Zone" � '✓�`'
at j a ri e- �iJ � Occupancy
to be occupied only as _ �� Parking Space 2
in accordance with Plans, Spec' cations and Plot-plan filed herewith. Fire Sprinkler
Estimated Value of Improvements, $
Exemption from requirement for State of Californi or ontracfor's License is hereby claims by undersigned:
as owner ❑ statement filed ❑ Q
Undersigned attests that his State of California Contractor's License $E'er/✓ 39
is in full force and effect and properly authorizes this application.
San Jose City Business License # /6 d v/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 7 �� >, �Pt a/fSsvo� �r Address
By,,a /� �j ti✓Ri�2 Address
99/8—W01—1-08Z w,oj
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N01103dSN1 dO 480038