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Tract No. Lot No. L
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT_
Date k'3 , 19� Permit No. S Y 7 Z /
Application is hereby made for a permit to x%?; //
a_L_story, Type J, wilding Use Zone � b
at '/ /w Occupancy
to be occupied only az "rt. arkin Space Z
in accordance with Plans, Specificatig at-ye '� prinkler —
Estimated Value of Improvements,
w/$
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License # 13- 1 /939G
is in full force and effect and properly authorizes this application.
San Jose City Business License # 21— '/O
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.
Own;r,�. / �� ?sao AL.Address // 9J' �v &zy 9y 5-
BLy— Address
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