41019 CRI 6 SAN JOSEumas BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT.
Tract No. �..!.�..:.. Lot No. --7't.......
3 _ Ifo/y
Date.--------......-.............._..�1.....:....... 19613- Permit No...--------...... --
Applica#ion is hereby made for a permit to ._ 0 ` ------
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a
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a------- ------story, Type--- . ..... ---
-----------_....1..�.�Building
Use Zone . ..----.
at ..... ---V.7.Z...... .. .- -- _.....' ---- � Occupancy
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to be occupied only as mg ace .._..Z.........--.
in accordance with Plans, Specificationsan Plot-plan filed herewith.
Estimated Value of Improvements, $ -
_
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 Sen 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 t violate the workmen's compensation laws of California. '
Owner v-..�_-- _ Address /.-`�...7
contractor , //l, ..----.Address q. .- 4a J//�� ��- ------....
ByA9�nf�-Y�.... O/�5/ .. . .........�..-.--.. �JZ3 .L .. ._: .
Form 260.1 7472 Dumas .2-2G—Cl/ E. Gregory
RECORD OF INSPECTION '
Foundafion ----- r1. Fr 3 - ), 6 o - 3 --
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