31276864 :a
864
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT 91'0,,3
Date---------- ; l"' g
��.------- 19 �� >' P rmh No..-.G./..o� .f'0....
i, .
Application is hereby made for a permit +o --...-----------------------------------
-
-......----"---------------------
a -----------/..story, Type ... --- J---------------------....-��-Z--- -------....---......---Building
at-------------------------------- .---r--....-.....`---------.....--.........--
to be occupied only as---- ................................._.............
in accordance with Plans, Specifications and Plot_pla itrewfiK?�/V/V
Estimated Value of Improvements, $--- /...G -`!-.fes
It is hereby agreed that the requirements of San Jose Building end 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.
1 certify that in the performance' of the work for which this permit is issued I'shall not employ any per-
son in any m,"ner so as to become subject to the wo rkmon's compensation laws oofCalifornnia. '
Owner
By
Agent
Form :eo-1
864 Grimm su Y" Loma Verde Const.
`%-� Z`� "
RECORD OF INSPECTION
,2-,3
omcco----------------------------------------------------------------- V Finish .......... "—,:_.,