54342 1174 Bubb
Tract No. 3! 2 Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
/ APPLICATION FOR BUILDING PERMIT
Date-7 2 19Permit No.
Application is hereby made for permit to 13&40 Q
a 2 story,'Type -Lr-- 1&Building Use Zone-&/16C
at 11-2 -�jua a _4D . (°/d0 /°4A �� Occupancy
to be occupied only as /-/=AM/LY R:� Parking Space_2—
in accordance with Plans. Specifications and Plot-plan filed herewith..
Fire Sprinkler
Estimated Value of Improvements,
Exemption,,froomm requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner 2 statement filed ❑
Undersigned attests that his State of California Contractor's License # 3-1— 113741 ..
39G1
is in full force and effect and properly authorizes this application.
San Jose City Business License #* fO EV Rf
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.
Owner U E7?d' SSoC. /-^Y.Address//15 " S ff IW4 r �f 15.
B
Address
99/9—viol—I-08Z w,oj
/— 7 4s[u!d� ooan}g
9 uoi}epunod
N01103dSNI dO a21003a