52984 1131 Elmsford 'Poor
Tract No. 3�l Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
jo APPLICATION FOR BUILDING PERMIT
Date 17 1967 Permit No._.�—Z—p
Application is hereby made for a permit to 130f40'
a Y story, Type ,Buildi Use Zone.R_W�—
at E/As U rte/ Occupancy
to be occupied only asr A/� Lt . �—Parking Space 2
ire Sprinkler
in accordance with Plans, Specifications t-p n i e
Estimated Value of Improvements, $-RYt you
nt for State of California for Contractor's License is hereby claimed by undersigned:
Exemption from roq uireme
as owner ❑ statement filed ❑ # �—/ /5J t`/
Undersigned afteo, that his State of California Contractor's License J 77
is in full force and effect and properly auihorixes this pa pplication, �u
San Jose City Business License #' SOS
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any me or so as to viojae.thsyorkmen's c qq�'pensation laws of California.
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