52984 1127 Elmsford Joe
Tract No. /Z ` Lot No. 4 y <
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date 3 — 17 19L7 Permit No. �Z� rU
Application is herebyade for a permit to Rwf4'f)-
a�sto{Yr�// Type g Bu'ldi - Use Zone,Q_�_A
of //Z7 F&I ,/ ''�/ Occupancy
to be occupied only a ar�in Space_rte_
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in accordance with Plans, Specifications an Ian i e rewit .
Estimated Value of Improvements, $ 20 duTy
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑ 13-1—
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 # y /ol"'V A0 '
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any me ser so as to si late ha workme_n's compensation laws of Califor is F _fp�,�I7�
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