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CITY OF SAN JOSELoT��,AChSWUy LRACT 2167 BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
ISEP 2 3 195Y __..:...195 ---------
Date---------- - — -. ... --
Application is hereby /madei for a
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to be occupied only
Permit No..r..Il.---{..�/--------------------
Building
in accordance with Plans, Specifications and Plot plan filed herewith.
Estimated Value of Improvements, $_//�--�%.D�------.
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 com-
plied 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 to become subject to the workmen's compensation laws of California.
^rt aunt= T. I INDSAY`1NC. AAA,.. a Tinn .ct-namino.Real-------- ..._- ---
Menlo Park, California
.—-
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- ---- ntractor, Agent
Form zW-1 �i
�1:
RECORD OF INSPECTION
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