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CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date.................7 ---------------- .. Pirrmif No...OZ49.1"Y-----------------
-------- ..
Application is hereby made for a permit to........./ . ---------------------------------------
a...------/....story, pe --- -- ... ... -- - ---- --------- -------------------------------------Buildin'g
at.---------------- -------- ---------- ----- . ... . ........... ......................................................
' : /,—1—,-f-�
tobe occupied only as....... ------------- -------------------------------------------------------------------------------------
in accordance with Pi 5, S icafions lo I 'I a *f Is.
Estimated Valu, Z5 �5mis, $.... .. . .. -------
If is ,hereby agreed that the requirements of the San Jos •Building and Zoning Ordinances and all other
laws 'applicable to the construction, location, and use of buildings within the City of San Jose, will be com-
plied with.
I certify that in the performance of the work for which this permit-is issued I ihall not employ any per.
son in any manner so a, to become subject to the workmen's cornponiation laws of California.
I .
C�!Aj J�qg-?....Addres's-----------4!12--E...1-----Camino Way
--------------
......Address.........-Palo ..Alto
......... ..........................................
By.
Contractor, Ag
r'o" 2 280-1 9 3 a toi�ng�f Od
Sol 9 71 �Bi a z Ood Wheatley Const.
RECORD OF INSPECTION
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