40113CITY OF SAN JOSC>��/ T
APPLICATION FOR
Date-
Appplplication ,is h rgB r d rmi+ j
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BUJILDING DEPARTMENT
BUILDING PERMIT
Lot No,�?...---r
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Permit No. -- - --- - ------------------
Building
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��� � Occupancy
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#o be occupied only as �....... � Parking Space ......................
in accordance with ens,`Speeifice+iioons and Plot-plan114• ed herewith.
Estimated Value of Improvements, $..Ll� /....
It is hereby agreed that the requirements of the San 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 be
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 a ,to violate the workman's compensation laws of Califcra'
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Owned.:/.i-`-�-----------------*---- �....
ByAQ.ahr--- --�� Gc : 6C -C-------------------. Address• �- --- -----�-----
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Form 280-1
RECORD OF INSPECTION
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