32066674��e
CITY OF SAN JOSE LI BUILDING DEPARTMENT ;
/ 'APPLICATION FOR BUILDING PERMIT[ /
Date ..... h�/---------------------I957q.. Permi No.3c:20 .9-----------------
f. Application�is hereby made for apepermit
_Ato..._.N__,m..............................._.._----------...
a.---------./- story, Type....._ -.14[--------- -------------------------------------- Building
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at------.... ------` % L1-.- ----------------- --- •/J_` L ---=------------
to be occupied only as ......... 1... Z l ---------------- AAr........
,
in accordance with Plans, Specifications and Plot -plan filed herewith.
Estimated Value of Improvements, $..jO.l--- ??9..
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 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 }ubject to theavorkmen's compensation1lasws of California.
I / ,/ 1 � cif- _ -.I— I--&' - - _
Contractor. Agent
Form 200.1
RECORD OF INSPECTION
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