38151 7585 H614ih
CITY OF SAN JOSe BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date --------------------------- 19,, Permit No..J_ 10-----------------------
Application is here6 made for a permit to -----------------------------------------------
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tory, Ty e.- - ---------------------------I--- ---- ----- ------------------------
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to be occupied only a, — --------
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in accordance with Plans �,iPZ!��47ns argelvw4e
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Estimated Value of Improvemens, ----------- -----------------
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
complied with.
I certify that in the performance of the work for which this permit is issued I shall not employ any per-
son 7ina manner sot.s to violate the workmen's compensation laws of California.
/0 CO
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Vwner Address ... .... ---------
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By
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Contract4r, Agent
Form 280-1
RECORD OF INSPECTION
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16 3 �:
S+ucco L-up e-
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