31079 160
CITY OF SAN JOSE ' BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Daf a----- __/----------------------------- 19.-S-7 Permit ---------------
Applic fion is hereby made for a permit to..... -------------------------------------------
story, Type--- -------�'P___41t. ...........................................................Building
.161"77......... ..... ... ---------------------------------------------------------------
----------- ----- -----------
tobe occupied only as. .... ...... ... .. ........... . . ................................................................
in accordance with Plans, Specifications and Plot-plan ed-he
Estimated Value of Improvements, $12......2... ----------
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 theperformance of the work for which this permit is issued I shall not employ any per-
son in any manner so as to become subject to the workman's compensation laws of California.
Owner.. ,-t l -7 �z
...... ........... --------------- ----....---y........
Contractor,
--------------- ---------------------
Contractor, Agent
Form 280�649 Erin Loma Verde.
RECORD OF INSPECTION
Foundation.... . ------- ...._...----- --.. ..... . Frame
Stucco................................
------------------------------------Finish-,................ ........
--- ---- ..............
Z�731,3