32066 t373. Li1yL<,�y,�v� �o.�. 1/r�'�
CITY OF SAN JOSE BUILDING DEPARTMENT
�►PPLICAYIOPI FOR BIIILDING PERMIT
Date.....4..Q ----'.Y./_ -'----......._..195-�- Permi# No.....�-DZ---------....-'-'----
Applic tion is hereby made for a permi+ to....�� .
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a--------1---.etorY� TYPa-�--... - -- ....._..--- .._........_.... f'�^�'l1f.....-- -- Building
e#...-----...----'-� --...��'"� Z---- -�r'--.2.5'.�..��. -�Z�.�_�1.---�..�1.�� -- ,
+o be occupied only as--- - ----`-�Gd�f<14,....----= - ..... .............-� -- ...---..._-- '
' in accordance wi4h Plans, $pecifica#ions and Plof-plan filed herewi#h.
Es+ima#ed Value of Improvements, $.../.�.���....
I+ �is hereby egraed +he# the raquiroments of the $an Jose Building and Zoning Ordinences and all o4har
laws applicablo io fhe cons4ruciion, locetion, end usa of�buildings within }he City of $en Jose, will ba com-
plied with. .
I cerlify fhat in ihe performance of fhe work for which fhi: parmi+ is issuad I shall nof amploy any per-
� son in eny y�anner sa es,�t/o baco/ma subjacf io 4he workmen's compensation laws o4 Celifornie.
' � -� � p�/�S�cuy.. . -
Owner-/��t- 4�7�L-�.- ._•. _Addrezs(��T`---- —
.....
� --.......Address .....- --" - �.. ---" - "- ........
� BY... C� Confmctor, Agant�e��.
Form t80�1
�, � RECORD OF INSPECTI N
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