31670 831 at*" kit$'•, . -
CITY OF SAN JOSE - 4.e/' S BUILDING DEPARTMENT
APPLICATION. FOR BUILDING PERMIT 77
Date:.._------_:...........-�^ ��--..... 19�---- Permit No.._� �� . . '- --
Application is.hereby made for/a��permit to------ ...`'«..............................................
a............ story, Ty e... Y` ..... �.. ' Building
at...-...� ,�.... .. '- ......................................-- -....----------------......----•---....
to be occupied only as........Z_cs ..-- -.. .- �-------• --- --�-+''..........--••--------
in accordance with Plans. Specifications and Plo - ISn fil d erewi h "'
n
Estimated Value of Improvements, $._.�:�..Owe?............
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 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 anyy manner so as to become subject to the workmen's comp�e�nssattion� laws ofp California.,
Owner---Ic u°ruA-v r!.. ...Address.....
Y".......................................................
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�By_ /4tAt.l Q . ...._.Ad\dress. '-
— 1
Contractor, Agent
Form 2800831 Grimm Loma Verde
?' RECORD OF INSPECTION
Foundation... ---------- - --
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Stucco................. ..........--..............................Finish-------/G..-1-- = .° v Q