31276 (2) • 828 . �itt1 / '
CITY OF SAN JOSE (�� ,BUILDING DEPARTMENT
A PLICATION FOR BUILDING PERMIT
Date........... ------ - - -----• 19.i„� _Fermi No. 5 :.
J`'� /o.�`�r/J .S L..sl..>.�
Applic tion is hereby made for a permit to.. --------------------------------------------
aBuilding
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to be occupied only as....../. -------- /� .............................
in accordance with Plans, Specifications and Plot-plan filed herewith.
Estimated Value of Improvements, $.-/'K� .
It is hereby agreed that the requirements of�fhe 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 bb come subject to theworkmen's commpeensafioonn�laws o California.
Own r.- :� ..I-;r: ....�;: ...Address!..- ...../.��
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Address..............._------------------------------------------------
Contractor, Agent
Form �`"Z8 Grimm, ✓f_s2-_;;,7 Loma Verde
RECORD OF INSPECTION
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Stucco...............................
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