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Tract No. 41-2S�{ Lot No. SS-
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT �/
Date /0/a3 , 19to7 Permit No. SZ
_j_ S 3
Application is hereby made for a permit to 2w I d d
a I story, T e W Use Zone%��
at SG /�/ Occupancy y'
to be occupie ny as FAw , 1 Parking Space Z—
in accordance with Plan , Specifications a Plof-plan filed heJewi#h. Fire Sprinkler
Estimated Value of I o ents, /G/
Exemption from requ,r o state of a is or rac or' ice s hereby claimed by undersigned:
as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License # B—
is in full force and effect and properly authorizes this application.
San Jose City Business License # 41 ' GOSSIP
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 1aIs to violate the workmen's compensation laws of California.
Owner �• rt'kv ker so c. Address II 7S $ • ('�`"H 9
y- Address
99/5-W01-1.08Z
ysiuld
euieid L .� i uoppunod
NO11O3dSN1 10 G80038