30838 7570
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FO�,OBUILDING PERMIT API03
bate-------....... .-..-:...195.7.:.
R. '3-'F'Permif No------
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Application is hereby made for a per it fo�--- ..............i-1.......................
I I -
a-------- --------story, Type... ---------- --- -- ---------------------------------------Building
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r. .--.----*----------
-- --------*---------- -- ---------- ----------
to be occupied only as....-- -. . ...... ............
in accordance with Plans, Specifications as d Plof-plan filed herewith.
Estimated Value of Improvements,
It is hereby gmecl'ihat 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 conn.
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 so as - 9f 'if
son to b;p*mo subject to knien's comp'ensation law; 51C
Owner-
X
Ow --Addreis.
BY- - - rs6'' w.k......Address........-...............................
Contractor. Agent
Form 2804 7570 Erin Loma Verde Const.
RECORD OF INSPECTION / ,Q
Foundation----.............-......-.......... �L." ........Fr6 .
Stucco.........:................... .Finish-
32 7,/7
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