3291 C141012 SAW50"S't"'tot 192 BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date......May...6.1.............................1 19..._69.. Permit No.......3.. i..........
Application is hereby made for a permit to ......cons.t=,Lct..........................................
&Siagl.e...sfory, Type.—L4....K�qgij-4.e.ii-c.................................... ................................. Building
at ......
to be occupied only as ...s="gerfef ami.ly dwel'
;i'l
ng
) s )
in accordance with Plans, Specificafio S -
/ ,Fp1w
Estimated Value of Improvements, $...7-12 0-Q.+0...........
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 +he+ 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 workman's compensation laws of California.
Owner .. Conqti,-ictj-on..00.....Address .......
..... .............. ---------- ........
By .. 1-7-... _......Address .......Falo...UPQ..... .............................
�ontra'-tor,
Form 280.1
RECORD OF INSPECTION
Foundafion 47ejq7A.v.------/.9 .7<Mtt Fam* . .&e..'b-7i-.lid
st,��- --------------------------------------------------- ---------- Finish
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