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52758 1161 Crestline Tract No. Lot No. CITY OF SAN JOSE I BUILDING DEPARTMENT APPLICATION FOR BUILDING PERMIT Date 3 — /S , 19 6 7 !• Permit No. 37Z- 76-,j Application is hereby made for a permit toasxU ZZ-- e '' •T Story, Type in9.;,., Use Zone Jq I•V3 of ///�/ r' J Occupancy_ to be occupied only as '/ "r Parking,Space Z in accordance with Plans, Specp an n i pKiith. Fire Sprinkler Estimated Value of Improvements, $ Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned: as owner K statement filed ❑ Undersigned attests that his State of California Contractor's License # ! is in full force and effect and properly authorizes this application. San Jose City Business License # �- I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to violate the workmen's compensation laws of California. Owner or✓/x� S 621En/S/CZ Address //6/ By +� dJ1 C, Address //Z� !/ 016aSTi- ry£ D/L S 1161 Crestline Donald Schemenske �— ti 99/5—W01— On m�aj ysiw j o»n}S ewai j uo Ppuno j N01133dSNE d0 MOM ! . a r