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CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FMBUILDING PERMIT S,
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Date------- ........... 19 ... ... % Permit No.
-------------- ..............................
Applicati n is hereby made fora permit to... ...... . ... ......................................................
a-----------F-----..story, Type -.
- ------------------ ...................Building
a#........_111-.................. .. ..... . .... ... .... -- -'--- .. ..............I............................
to be occupied only as..-- .. .... .. .. . ... .....I.................
in accordance with Plans, Specifications and Plot-plan filed herewith.
Estimated Value of Improvements, $...
_
It is hereby agreed that the requirements of f;7a. S`an__J,os_e 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 manner so as to/
o become subject to the workmen's compensation laws of California.
OwnerI �ft
.. . . . P" Address..--------------------------------------------------- ---- --
.. . ..._9 ddress............................................................. ...
By----------
Contracfor, Agent.
Form ftl Rose Blossom Loma Verde
RECORD OF INSPECTION
Foun1�
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