33364 I 77 4 tIIA6 way
CITY OF SAN JOSE /L 0 7- V3 BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT q6 (
Date------- / 0 Permit No--- ----- ............
...... .......................... l9..6!..0 I
Application is hereby made for a permit to .... -�>
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I
a-----(------------story, Type']7...... -- ------- ------- -------------- Building
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to be occupied only as
in accordance with Plans, Specifications and Plot-plan filed herewith.
Estimated Value of Improvements, $.1350.S.--Q- --------------
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
complied 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 so as to �iolate the workman's compensation laws of California
'o
Owner
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W Address
n
By ---- - -- .....Address .......;12,11at 'a...paxah..........
_&nt far, Ag
Form 280;1„
RECORD OF INSPECTION
Foundation -------- 2"6d- a- 9
-- -------------------------------------------- Frame -;,---- -----
Stucco -------------------------------------------------------�inish
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