40113CIMOF SAN JIISFt� BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Tr ct No.� O. 1. ... Lot No. 'Z. 7-----------
Da+e_ � ......... .. ....-----------, 19.�:. L �j>�rmi+ No. Q..l-,3---------------
Application is hereby made for a permit tc(-e ' ..............................
a ......... /.... story, Type- - - ---..... ..jx/__---------------------------------ding
Bu
Use Zone..
Occupancy ...... -----------
to be occupied only as ..�...�...._........ ' / / r'�6XParking Space .................
in accordance with Plans, Specifications/and Plot -plan fi»ederewith.
Estimated Value of Improvements, i -.,l -- ----- ..... .. . ---
It is hereby agreed that the requirements of the Sen Jose Building and Zoning Ordinances and ell 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 o as jo violate the worrkk�men's compensation laws of California,
Own.�.,.c'...../'..�!�s*'-!/%.---..._..........._....... Address
contractor CAddress
ByAgl.._..s.._..............................__..
Form 280-1
RECORD OF INSPECTION
un6ati -".. p
, r� a ( / 2----- ---------
C L
m - ---------------------------- -
. ......
--------------- ....... Zn i msh ...... - ------------------ --------