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Tract No. ? Lot No. Z
CITY OF SAN JOSE BUILDING DEPARTMENT
y APPLICATION FjQR7 BUILDING PERMIT
Date �- / , I Permit No. 5- - 7-
Application is hereby made_ for a permit to Coo,#tTrP vGr- d
a_2 story, Type A P�u�ddi�n9�/, Use Zone
at /103 X F 0 `vv Occupancy
to be occupied only as S-Mw' 4C 509vr►.�CJ . Parking Space Z
in accordance with Plans, Specifications an ith. Fire Sprinkler
lot•plan filed herewy
Estimated Value of Improvements, $ �• e ��/
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑ q y 3 5 /
Undersigned attests that his State of California Contractor's License #13-1
is in full force and effect and properly authorizes chiQs applicafion.
—
San Jose City Business License #-4--
1 V s / g '
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 yiolate the workman's compensation laws of California:
Owner .T. H0.VTt0P *"OC- Z'A/C. Address./ ?? S NNr f .SNS TnSt
By Address T4A4X AJ' A(A0✓L
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