55253 758 Barnhart
Tract No. q a1Lot No. 33
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT J
Date 1967 Permit No. 57-57 i 513Y
Application is hereby made for a permit to
a story. Type Res ildirng Use Zone
at S88 00/ '' Occupancy —
to be occupied nl s Parking Space 2
in accordance with Plans, S ecifications and Plot-plan filed wi,h. Fire Sprinkler
Estimated Value of Impro ments, $
Exemption from requirement i t o Celiforn' t r' is ha y claimed by undersigned:
as owner ❑ a mant fil
Undersigned attests that his Ste of California Contractor's License # a� 9396/
is in full force and effect and properly authorizes this application.
San Jose City Business License # 4/— /aS'/8
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.
Owne .5 . (4c, e r4Address 1175 S. Hwv Cl
Address
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