55253 10 �, a7§4E Barnhart
Tract No. S�as// Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date /,�/23 , 1967 Permit No. !25-2-S-3
✓�
Application is h y mad ora it to r Hu. 1 d
a I story, T 9 Use Zone lB6
at (o 4, COccupancy_L
to be occupied only as I Fc m, �� Parking Space -Z-
in
in accordance with Plans,Apecifications and Plot-plan filed herewith, Fire Sprinkler /
Estimated Value of Im s, $
Exemption from req uirem1000.15 of Califor f on rac ox's icens aby claimed by undersigned:
as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License # B— I 19396/
is in full force and effect and properly authorizes this application.
San Jose City Business License #� -�O Sy�
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.
Own
7B f un e SSoc. Address II 73 S. N ' `i
Address
_71
99/5—W01—I o6z w,°d
L� � 64 --::�2
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