NO PERMIT NUMBER 808 'Rose Blossom
CITY OF SAN JOSE BUILDING DEPARTMENT
/ APPLICATION FOLDING PERMIT
Date--'----f Y_`.5----------_----:...19�� - r Permit No.........-..............................
Application is hereby ma for a permit to.�r --------
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a-------.-- - --story, T¢YP /,�------------------------Building
to be occupiod only as....-- --- . - -----------------------
in accordance with Plans, Specifications
?and
�P-lloott--plan filed herewith.
Estimated Value of Improvements, $../• ?..- --v..(/
It is hereby agreed the} 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 com-
plied 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 ma nor so as to be oma subject to thew rkmen's compensation laws of Ca ifoyrn�i .
Owner...
By_.... - '-
- --------------Address.......------------------K------------------------.b---
Contractor, Agent /���
Form 2e0-1 808 Rose Blossom Loma Verde
RECORD OF INSPECTION
F ion 3 -`-'..:�`� Fre_ !-ZL AV-- '9
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