43892 CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
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Tract No. ......... ---------- Lot No. '��...............
Date..2114..................------------------1 19....(./ P rmit No.434?-�L_ ___V
Application is hereby made for a permit td/...''.........' ............................ ..........
a..../.......story, Tip;;----7_ - ;_��--- ---- --------- - ---------------- --- Building
q_ " _& Use Zon
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at
&ccupancy ..........r-----------
to be occupied only as Y......I ........ Parking Space ......
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in
----------in accordance with Plans, Specifications and Plot-plan filed herewith.
/
Estimated Value of Improvements. -----------�_--
It is hereby agreed that the requirements of the Son Jose Building and Zoning Ordinances and all other
laws applicable to the construction, locafion, and use of buildings within the City of San Jose, will be
complied 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 vio[ate the workmen's compensation laws of California.
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Ow 40!v�- ----Address
Contractor
- --- -------- ------- --Address/' ------------
-------------------- --------- ----- ......
Form 21
RECORD OF INSPECTION
Foundation .4 17 Frame
Stucco ---------- ---..................... ----------- --------e-IlFinish --- ------------