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Tract No.4,2S-41Lot No. 3
CITY OF SAN JOSE BUILDING DEPARTMENT
APP ICATION FOR BUILDING PERMIT
Date ( 19 lo� j� Permit No. 5 / .2 2
Application is her by made for a permit to 1- 4 e /�
a_/ story, Type e.3 Building Use Zone �
at e �i� Occupancy_
to he occupied only as - 4 Parking Space 2
in accordance with Plans, Specificationf lot-pla filed herewi Fire Sprinkler
Estimated Value of Improvements.
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑ /t
Undersigned attests that his State of California Contractor's License # 13-1 193 ? 6 /
is in full force and effect and properly authorizesthis application.
San Jose City Business License # y _/6s;f S '
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 -;Xe SSoc -V . Address -/ ?,)J -o /�i✓rn 9•
By + Address
l/ r /
79/9 — viol — I'OBL —01
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