52969 1140 Elmsford L
Tract No. 3/ Z Lot No. .? _
u`
CITY OF SAN JOSE BUILDING DEPARTMENT
y,/ APPLICATION FOR BUILDING PERMIT -$2V4 c ,
&
Date � 6 , 19 ` 7 Permit No. ,5"12-
Application is hereb made f0-aefo)
a story, Typetil Use Zone
a} CIM S Fv>W0 (� {� Occupancy 7r
to be occupied only as "_& Fr4i�•}• IPLb�-� l�l��/ king Space Z
in accordance with Plans, Specifications and Plot plan fi ed herrewit (Fire Sprinkler
Estimated Value of Improvements, $�N�000 • IgG -rib
Exemption from requirement for State of California for Contractor's License is hereby claimedbyundersigned:
as owner ❑ statement filed ❑ 3. G/
Undersigned attests that his State of California Contractor's License
is in full force and effect and properly authorizes lh application.
San Jose City Business License # Lf IOSy d
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any manner so as to violate the workmen's compensation laws of California.
Owner R.T.an6�
Oer/C �Vw$ f !tEA&g ..�n/�. Address /I;.!`•S. Hwy.
B�.:r Address rte-_
Y
_ 99/9—No$—DOBE wjoj
000n{S
aogvpuno j
N01103dSN1 40 480038