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CITY OF SAN JOSE / -1 G BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date-/../...-�.�----... 19.x-...-.- �QPermit No.3.0_C..S-f---------....---....
App//plication is here de fo ermi+ tll ----------------------
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to be occupied only as /-—--- ._--�C.//
in accordance with Plans, Specifications and�>�plan filed her ith.
Estimated Value of Improvements, ------------------ ........
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 in any manner so s to violate the workmen's compensation laws of California.
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By✓ / � f�j -`--- ------.Address
Contractor, -Agent
f�r,n 790-1
RECORD OF INSPECTION
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