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CITY OF SAN JOSE r BUILDING DEPARTMENT
APPLICATION FOR BUILDIN7
jC PERMIT
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Tract Na .. .o.... Lot No.(/. __c- -------
Date... .........
.Date... .......... . ...1..` -- ...14----- 19 - ^�ermit No. -!..V...�1.Q. ......
Application is hereby�rn a for a ermi+ 6/�-�-/-------- ---.----`---......._.....-----................
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Use Zone ----------------------
at .....l..- ....... - - .. - .. ............. Occupancy
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to be occupied only as ---------------- ------------------- arm Space ---------------.._-.
in accordance with Plans, Spe f o en�rttl e�
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Estimated Value of Improvements, $--------- ----- 1..----..._.
It is hereby agreed that the requirements of the Sen 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 perfcrmance of the work for which this permit is issued I hall not employ any per-
son in any manner:so asJ0 violate he workmen's compensation laws of Celiforn a, —
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Form 280.1
RECORD OF INSPECTION
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