52252 1104 Elmtldi l
Tract No. 31dR G Lot No. #?
� CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date / - 9 19 & 2 Permit No. 1--2-
Application
zApplication is hereby made for a permit to C&4zsTW0a
story, Type laurfd+ Use Zon4?--_L
atf e a* ST/9lp"o-o Q/1 {)oe&-y r-St. Occupancy
to be occupied only as �Lf Parking Space
in accordance with Plans, Specifics ons and Plot-plan ti el d herewf}h. Fire Sprinkler
Estimated Value of Improvements, $ / r1t 0 00• 60 j -
Ezemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License # /�/�� ♦ I
is in full force and effect and properly authorizes this application.
San Jose City Business License # 4- /as g 0
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any manger so as to .-iolate the workmen's compensation laws of California.
Owner /!' T H✓��� Ift - Address 1171 t/ /r JAtN f
6
BY "�'—��• w� Address fQ.i! T4s 14.3.4✓r
99/5—W01—I'OBZ w�oj
5 � Jlper/-srs��� L c�. Z T5 4slsluui�ld 000n}S
NO11OUSNI dO 080038