52469 1124 Elmsford 2&& i3
Tract No. /26 Lot No. 31
CITY OF SAN JOSE BUILDING DEPARTMENT
` APPLICATION FOR BUILDING PERMIT 04 U-L
296
Date �• 19 � 7 3 Permit No.
Application is hereby_made for a permit to
a story, Type_ BYlldin /� Use Zone 040
at Y alt's FriKO Occupancy
to be occupied only asSAV6WK Parking Space z
in accordance with Plans, Specification�a PI6 /nWU ' i h' Fire Sprinkler
p o-
Estimated Value of Improvements, $ (t 0��• G��•y�
Exemption 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 #}' 7
is in full force and effect and properly authorizes
this application.
San Jose City Business License #k
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 violate theworkman's compensation laws of California. _
Ow er UNTf'P ssI,���9tjC. Address/��s S y I 'StJ•
By `�l�'• V• . Address Ainw-44, 6cf�^'G
99/s-WOI-1 08Z -1-j
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