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Tract No. �J Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APP ICATION FOR BUILDING PERMIT
Date r) 196 Permit No. 5 y 7 Z
Application is here y made for a permit to Jahr r /a/
a_ _story, Type --br oes Building Use Zone
at — ✓ Occupancy_
to be occupied on �� Parking Space Z
in accordance with Plans, pecifications a d Plot-plan filed herewith. Fires Erin
kler
Estimated Value of Improvements,
Exemption from requirement for State of California or Contractor's License is hereby claimod by undersigned:
as owner ❑ statement filed ❑
Undersigned attests that his State of California Confracfor's License # —/ /9391& /
is in full force and effect and properly authorizes chis applic tion.
San Jose City Business License #' /0") I?
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 o 'f e✓ ��SS o c c•Address
S.
By� �9� Address
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