55253 -PlAr 33g1� Barnhart
Tract No. `taSy Lot No. 3�
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date /61a3 , 1967 Permit No._j,S2S3 ✓!/
Application is h eb r
astory, Ty in Use Zone AI'46
of 76/4 'Occupancy_��
to be occupied only as I-O.YN I Parking Space �L
Fire Sprinkler '
in accordance with Plans, ec' ' fion�d t- n r t
Estimated Value of Imo me ts, $
Exemption from requirement for fate of Calif rnia for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes this application.
San Jose City Business License # 4 ' �OS7 8
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any mknner so a1sl to xio11lato the workmen's compensation laws of California.
Oti___ tT. Ac-k tee +ASS oc.:E�,•Address 1175 S IAwq 9
y Address i
99/5—1401—I On w,.i
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