3458511( TYQ�F` SiR� JOSE • L / BUILDING DEPARTMENT
APPLICATION /FOR BUILDING PERMIT
Date ...r�..... ... ....- 19.-" ermif No.------ - 5
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Application is hereby m e for permit #o------ G
c+erv_ Tsroe ---------------------------------------------------------- Building
at Zz.0
to occupied only
in accordance with Plans, Sp- eci-f, ictiod f 14415? it �
i#h.
Estimated Value of Improvements,
If is hereby agreed that the requirements of +he 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 ��' the performance of The work for which this pa IS issued I/shall employy- par-
son in en arfn r so esa violate iha w/o�rk'm/en's compensation laws of CelifoJr�mje.
Own ..e.l"�.-1G=U�I:�.�-.-.Addres� / / ��/
Form 280-1 I
RECORD OF INSPECTION
Foundation ._.....//I-
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