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Tract No. Lot No. 7
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT—
Date
ERMIT
Date 70/2-3 , 1967 Permit No. S
Application is hereby made for a permit to SAL Id
ate story, Typed Res . B 'dip Use Zone. _���
at /641 H S' ' I-11R/C/� Occupancy ,T
to be occupied only as I N _. Parking Space 2
in accordance with Plans, Specific ions and Plot-plan fled terewith. Fire Sprinkler
Estimated Value of Improveme fX
Exemption from requirement for State of alifornf or Contractor's License is hereby cleimud by undersigned:
as owner ❑ statement filed ❑
Undersigned at that his State of California Contractor's License # "1 I9396 �
is in full force and effect and properly authorizes thisa plication.
San Jose City Business License # .4 - iosV6
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.
OO�e �, v r �er f-/�ssac Address 1175 S.
_ Address
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