33859 1144AMOSE BUILDING DEPARC?
TMENT
APPLICATION FOR BUILDING PERMIT
Date-------------7-(-7,-s-------------------1 194ro--- Permit No. 11KS0)--------------
Application is hereby made for a permit to ---- J,(.4152------
a....&.P.t!�---story, Type-- ----'----1./ -
-- - ------- -- - --- ----------------------------- Building
at
to be occupied only as -----.G_�J.�E.....7A-M-
in accordance with Plans, Specifications and Plot plan filed herewith.
Estimated Value of Improvements, $.-.-.1.1-_Q..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
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 workmen's compensation laws of California.
bwner Vcrx2_61 1.4... .....Address
_00�y
`Aj...By . x4 A24�fK�....Address
Contractor, Agent
Form 280-1 7787 Robiridell Ronald D. Anderson
RECORD OF INSPECTION
Foundation ------- Frame -------�""/�lTo--"--L--"----e---
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----------------- <Stucco ---------- Finish ----//A-------
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