30495 7409- Fallenleaf
CITY OF SAN JOSE •„'BUILDING ,DEPARTMENT
APPLICATION FOR BUILDING PERMIT
YR19T ??
Date........................ , 19 S / P rmit No..---......J .
Application is hereby made for a permit to---------------
a----'-'---`-----story, Type--------- ---- - --- --------���------------------Building
at------------------I...T.P_9t .---.--.----. �a..l.1.IC. I. r-- ....../.`- ---.--.....--�--------....-.....--
to be occupied only as---.- . ... . ..... . ....-...............
in accordance with Plans, Specificafion and Plot-plan filed herewith.
s
Estimated Value of Improvements, $. I- -- — ---------
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 in any manner so as to become subject to the workmen's compensation laws of California.
Owner_6-,Cr/`zz:-_AF-i 1:1....-C1h,�/Z----.Address.YW �ij�.-46610 "-9�'.1i4/YG`.
- ...... ..........Address---.........--------...--------------------------........-----
Contret
Form tae
1409 Fallenleaf � 3° ,�9 E. DeLaCruz
RECORD OF INSPECTION
Foundation.......:0 -Frarne....'-4
...................
Stucco--------------------------------