402121155 C Yas1y;KgW•7ay
CITY OF SAN JOSE BUILDING DEPARTMENT,
' APPLICATION FOR :BUILDING P RMIT
Tract No%�. z!_ Lot No.
Date..// "---- T D ft 1. b► -
19 �,�' Permit No . .............
Applicetion is hereb ado for a permit to��-------
/. story, TYp - P r ..............------------------ -R4184. p---- Building
p �> �! Use Zone R..:f'1. 4 .
at L/._..� ..... `�-= ....... Occupancy
-- ..
lG_?1if----------------_..
to be occupied only as.....~ -------
Parking Space ...... 1.. ---------
in accordance with KCAPecifiodfi6rrr d" Ifo+-�lefrd herewith. F�)
Estimated Value of Improvements, $../x� p o
It is hereby agreed that the requirements of the San Jose Building end Zoning Ordinances and all other
laws applicable to the construction, location, and use of buildings within the City of San Jose, will be
complied with.
I certify that in the performance of the work for which this permit is issued I shell not employ any per.
son in any manner o as to violate the workmen's compensation laws of California. /� r
`J G'....... Address/-.-Uj.
can
Macb
ByAa.ae . .r. �...� "---.. Address - ....--
Form 280-1
RECORD OF INSPECTION
F I I - 2
Foundation --- pu-6
- - --------- - - --- -------- ---------- ----------
Stucco
---- -- ---------- --- --------- .... .. .... Finish --- (�o
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