37542 CIAF 9XV*SE BUILDING DEPARTMENT
APPLICATION jllo(R� BUILDING PERMIT
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_�Z.7 J!--- Permit Date-------- .... . ...............1 19.
.......................
Application is hereby made for .3 permit to --...11'er
-- -------------------------- --------------------------------------------- Building
_story. Type -------- .-
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to be occupied only as
in accordance with plans, Specfi *Z`ati`c��of6n filed herewith.
Estimated Value of Improvements, $---
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It is hereby agreed that the requirements of the San Jose Building and Zoning Ordinances and all ofhc/
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 manner so as to violate the workman's, compensation laws of California.
C� 77 4
Owner ------------........ Address t_-- ---- ----------
W. --------Address --------
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Contractor"L?
By .....�VC----- A, enft Jn_
form 280.1
RECORD OF INSPECTION
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