31276 CITY OF SAN JOSE BUILDING DEPARTMENT
AJPPLICATION FOR BUILDING PERMIT
Date---------- -71�� Pe it No. C
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Application is hereby made for 7_e'mit +o....... .......'?�...........*......................
a'- story, ... ................. ----Building
-------- y Type -__= —
---------------
at...........................Wi...�2 . . . . .. ..............--------------------------------
to be occupied only as---- .... .. .... ---------------
in accordance with Plans, Specifications andPo,, Iviluc -4
Estimated Value of Improvements, $../-. -----------------
It is hereby agreed that the requirements of the So. 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.
certify that in the performance of the work for which this permit is issued I shall not employ any per-
son in any nner so as/to become subject to the workmen's compensation laws of California.
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Acldress.//a?�-7�.
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By..... 2 ... ....Address.........
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tc nt,)licfor.'Ageht
Form x,48 Grimm Loma Verde
RECORD OF INSPECTION
Foundation------2-71 ?
.................................-------0-------Frame.......
Stucco.................---...... .............................. ........ ..........
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