52969 1136 Elmsford 3�0�
Tract No. 312 6 Lot :No.-
CITY OF SAN JOSE BUILDING DEPARTMENT
L / APPLICATION FOR BUILDING PERMIT SSC.
Dafe ( CW• 6 , 19 G—? Permit No.
Application is hereby made for a permit to /3t/ILD
a�story, Type Building Use Zoned "�
i
a+ e, VATS Wo oe Occupancy L
to be occupied only as - rs Parking Space Z
in accordance with Plans, Specificati n=VV;rith. Fire Sprinkler
Estimated Value of Improvements,,, S.
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 #
is in full force and effect and properly authorizes is application.
San Jose City Business License #_-/Od TD
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 the workmen's compensation laws of California. 7-
Ow ✓wmo e. Address 104—S N�y
Owner 10
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