30838 7564 Erin
CITY OF SAN JOSE BUILDING DEPARTMENT
'APPLICATION FOR BUILDING PERMIT ?df—
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Date........- -------------195 Permit No.........--- OS_70.........
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Appli at;o�n is hereby made for 13 permit to _&C// -----------------------------------------------
---------------------------------------Building
---------/-----story. T_%pe__Ar�_
t.................. ... .7-fj<----------
I to be occupied only as.......... ---------
in accordance with Plans, Specifications and Plot-plan filed herewith.
Estimated Value of Improvements,
It is hereby agreed that the requirements of the San Jose Building and Zoning Ordinances and all other
laws applicable to the construction, location, and use of buildings within the City of San Jose, will be com-
plied with.
I certify that in the performance of the work for which this permit is issued I shall not employ any per-
son any m so as to become suble t to the wo.&kmen's compensation law f COW
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2, �dclress/
Owner...
IA Address....----------------- ------------------------------------------
By..
Contractor. Agent
Form 27564 Lrin Loma Verde Const .
RECORD OF INSPECTION
Foundatiom....... ... . 49�i�
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2s-4a
73 212.6--