50419 Z" 858 Lily
Tract No. Lof No.
CITY OF SAN JOSE BUILDING D PRTMENT
Date 6&0 APPLICATION FOR BUILDING PERMIT ��, 19 �L Permit No. 7 � 9
Application is hereby made for a permit to 13!/..J
a — story, TypoP__Wo Building Use Zone_
at g S lakLy ArYtr Occupancy J
to be occupied only as_�/t-IJ• /000L Parking Space
in accordance with Plans, Specifications and Plot-plan filed herewith. Fire Sprinkler
Estimated Value of Improvements, $ 3 O o U
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License # .:?— S U 15 3
is in full force and effect and properly authorises Ph/is app/lication.
San Jose City Business License # Q ` t`
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any nner(�`o es f violate the workmen's compensation laws of C tfi orn,W ^ „�
Owner ` t/ • �'��' S Address sd �f(�
By s L Address e?
e� • 5&i eAjr y
$58 Lilv . . D.' D. Harris
n RECORD OF INSPECTION
Fram
$fucco Fini: r17 (C1 SCC
Form 280 1—10M—5/66