53612 7573 Prospect _ 21
Tract No.-L J Lot No. S
CITY OF SAN JOSE BUILDING DEPARTMENT
_ APPLICATION FOR BUILDING PERMIT,'! C
Date S �G ' lg G 7Permit No.
y� S �fOI7i �7 r
Application is hereby made for a permit to f nye S77evci
a story, Type Building, ��) Use Zone.ISJ�2_
at �re�s f.cT .���/(/V Occupancy 2
to be occupied only a ,� Parkin ip�ce
in accordance with Plans, Specifications an Plop al v d heJewith�/���es
Estimated Value of Improvements, $/®j uvu
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑ �j / y 3
Undersigned attests' that his State of California'.Contractor's License # 1.3
is in full force and effect and properly authorizes
authorizes this application.
San Jose City Business License # 7 —/u S- '
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.
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