53612 7561 Proppect
Tract No-12—`�— / Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date r /619 �G 7 Permit No.
Application is hereby made for a permit toCTrrevL p
a Z �story, Type Bun iieg Use Zone.
at (g XOSPEC r /Cj . Occupancy
to be occupied only as ,Q P �v Space�
in accordance with Plans, Sp cific tions and Plot plan filed he/re/with. OFire Sprinkler
Estimated Value of Improvements, $ -2-0- a O u
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑ 3l_ 53 5 /
Undersigned attests that his State of California Contractor's License # '
is in full force and effect and properly uthorizes this application.
San Jose City Business License # /� O
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any manner so as to violate the workmen's compensation laws of California.
1 �J ! lam ✓it�e g ASse �. Zhti. Address 2 2 S/ c-y
Byw{'{'Grt� '7/ �XCt V• 'l� Address _ •S�"`e "� "'('"r '
99/S-W01-1`00L —01
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