3065675W_ MrIA
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR IWILDING PERMIT ��a3
Date lk.._7 Y 19 S Permi+ No..----------
Application is herebyy made for a permit tto........-: - %a:.l..�.
a........... /------ story, TYPa=•-`' _-'�--�-� 5.�1�`- ��%i.:w...--- .................Building
to be occupied only as----....... . ..... xt3..---. Cl eW!t.'r:- ...-'-....--..
in accordance with Plans, Specifications
and Plot -plan filed herewith.
Estimated Value of Improvements, $..../?
It is hereby agreed that the requirements of t e 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 in any manner so as to/become
susubject to •the workmen's compensation laws a '' al/iforniaa.
Owner......- - �/_�it[GC{! `�T4cl/Q. Address../k... ........ ---
Form 280.1 7565 morin Loma Verde
RECORD OF INSPECTION
...........
5-5- e. -A—
. ............ --------
Finish ..........