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CITY OF SAN JOSE "' / I BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date------------- ....... ......195.._I- Permit No......5z-4.911..............
Application is hereby made for a permit +o..........
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a..---------/----story, T ..... --- - ----- - ..... - - --------------------------------------------Building
at------------------ ---/. ---- -- ---------- . ...... ---------------------------------------------------------------------------
to be occupied only as----------- ------------------- ----n./
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in accordance with Plans Spec* tions 4 to ]an filed he ewiih.
Estimated Value of Imp Ke --- -- ---
It i I s.I here.by agreed that the requirements of the
San jo",'Buiiclieg and Zoning Ordinances and all other
laws applicable to the construction, location, and use of buildings withinAhe City of San Jose, will be .6m-
plied with. , I I % I
, certify that in the performance of th� work for which this permit is issued I hall not employ any per-
son in any manner so as to become subjea to the workmen's compensotion laws of California.
Owner I Wvheat1Constr. C !C,-.Aress........
I dd h,1 2 —1.. AM)C no -Y.174.3r
X. . .....L - ---- - ------- - -----
Addre�
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....
7A'
Form 280.1 9��-Blazi' od Wheatley const.
RECORD OF INSPECTION L
. ........... ...WFra -------............
Foundation................................... ---- ---- -----------------------
Stucco..................
................................................Finish......
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