40020 7C'j4;' OF SANkjwe��Wf� I_ BUILDING DEPARTMENT
V APPLICATION FOR BUILDING PERMIT
T 'N 0 1. .......
ract o L t N /
1 19 z--- �cYPermit No. -----------
Date ......
A'plicafion is hereby for a permit
P _-------------------------- .................. ...................
a-----/......story, Type. ----------- ------------------x... Building
Use Zone
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r at 3px Occupancy ...
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to be occupied c ............. Parking Space -----1.'x—-----------
in accordance with Plans, Specifications and Plot-plan filed rewith.
Estimated Value of Improvements, $_11S742.....a
..............
If is hereby agreed that the requirements of the Son Jose Building and Zoning Ordinances and all other
laws applicable to the construction, location, and use of buildings within the City of Son Jose, will be
complied with.
I certify that in the performance of the work for which this permit is issued I shall npf employ any per-
son in any manners as I late.5fhe k an's compensation laws of Calif
rr m
X��<Acldress/zl. ............GLr -------------- -
Own r --- ---
Contractor
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Lv
ByAqa�z---1,.!� ........ .......Address --------- -------
Form 280-1
RECORD.OF INSPECTION
-IFra ........12 -11- 62 k1,16
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