42217 12�2 OF SAN CITJOSPubb Rd.Y BUILDING DEPARTMENT
APPLICATION FOR BUILDING, PERMIT
Tract No.J-..f./....... Lot No. ..5/_...........
Date....-------.............0� ----------- 19_�7�__ Permit No.q�__2_1,7. .........
Application is hereby made for a permit to ---------------------- ------------------ --------_:-----------------
°---F------story, Type J�..zf --------- 4 .......42-7------- 4RAeZ
------- -- Budin.��J . .... . 9
at UseOccuncy ......r------------
to be occupied only as --- A, P— AA
.1----��a,5 Parking Space ......Z..---------
in accordance with Plans, Specifications and Plotplanfiftlederewith.
Estimated Value of Improvements, $..../Z.....&ip-4)............
It is hereby agreed that the requirements of the Son Jose Building and Zoning Ordinances and all other
laws applicable to the construction, location, and use of buildings within the City of Son Jose, will he
complied with.
I certify that in the perfcrmance of the work for which this permit is issued I shall not employ any per-
son in any manner so as to violate the workmen's compensation laws of Califc.rnia.
. Jr —
Owner A0 e�IeJ� t�14 i� .. 4� ?
0Addr ss
Cont,acto e.
ByAq.nt --------------------------------Address
Form 280-1 1222 Bubb Rd.
RECORD OF INSPECTION
Foundation U ��. .J..h`.''.�..�":\J.,...:...... Frame //'.--------- �..... ......�.!'`r:....
Stucco -------------------- -- - -----------_--- ---- - o0"'<ish .......