31276 882 041at�. TCiit4
CITY OF SAN JOSE hall BUILDING DEPARTMENT
PPLICATION FOR BUILDING PERMIT �O 3
Date..-------- -.. ..�.ty.--.'----------------_., 19.,5...1.. Permit No... 1..07 . ---------------
Applica ion is hereby made for a permit to..........................................................................
a.........../------story, Type-`----- ------------------- ------ ---/ .� . - Building
0
to be occupied .only as...../....... ' / C/ jam..'.............
in accordance with Plans, Spec ificationss and - Ian file fee ith. C�/V
Estimated Value of Improvements,
It is hereby agreed that the requirements o 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 any manner so as to become subject to the workmen's compensation laws of California. ,1
Owner.... K7� 11;44'0-"e
-�4ggL�d�F ....Address.//B '/V - .......Address.....-..---------------------_---'-------.... .--------......-y-.-... Contactor, Agant ` r
Form 290.1
082 Urimm Loma Verde
RECORD OF INSPECTION
Foundation...........
.....................---------------------------Fr m —... . .........
Stucco................................. tt r Zai C)
-----------------------------.....Finish..................................