52797 7582 Newcastle
Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date — /7 , l v G 77 Permit No. S'— 7f77
Application is hereby made for a permit to
a story. Type � ' Builaing Use Zone RIR16
at 2_ Occupancy
to be occupied only as � /b��P4��gpSpace =
in accordance with Plans, Specifications and Plot-plan filed herewith.
Fire Sprinkler
Estimated Value of Improvements; $
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 #
is in full force and effect and properly authorizes this application.
San Jose City Business License # '
I certify fhat in the performance of the work for which this permit is issued I shall not employ any parson
in any manner so as to violate the workmen's compensation laws of California.
Owner_ f n�14 w"�� 6'•J(AIX2 Address 75'11 �6 �GQSTLE 0Q' S'� "
By HrM.TrAJ "-'i^) Go,.zS T. C<. Address r2gY 4AAJSFQ2-0 /�'JG. 5•. J.
X82 Newcastle William G. Kaiser —
99/5-W01-I-OR -101
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