41894 6728 Clifford Drive
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Tract No. ..... ------------- Lot No. --------------------
Date.. .......6 7-Y-- .. .. Permit No. -------------
-------------------------- ........... ///YP4 1
Application is hereby made, for a permit to 10�2e2....?�52--------------................/...................
a------I------story, Type_eV�- , rl. ..........r....---.......- --- . - Building
at ...... ---------------- Use Zone ----------------------
Occupancy -----------------------
to be occupied only as 1W2 tl F,✓fr^u P�Wkg
Z -------- -------
Specifications d it .
in accordance with Plans, it X7,
Estimated Value of Improvements, $..../X----
--------------...........
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 San Jose, will be
complied with.
I certify that in the performance 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 California.
Owner •---
'W.------ I----- ------------ ------
contractor
ByAgent-------------------- ----- --- --------------- --------------Address ... ------------------------------------
Form 280-1 6728 Clifford Drive M. Clayton Henry
RECORD OF INSPECTION
Foundation
- -- ---------- ---- Frame ----------- -- ---------------------- ----------
Stucco --------- -------------
----------------------------------- ---- Finish ...