NO PERMIT NUMBER RECORD OF INSPECTION
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CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
TractNo-----------------------Lot No........---..........
Date....................................................... 19-----...... Permit No.. ........... - -
Application is hereby made for a permit to .................
a---.............story, Type................................................................................................... - Building
at -...........................--------- ------- Use Zone...-----..........------
to be occupied only as --------------------------------------
__- --
-------- --- _ -
---- -- Occupancy.................._....
- Parking Space........................
in accordance with Plans, Specifications and Plot-plan filed herewith.
Estimated Value of Improvements, $.........................................
If 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 the+ 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 workman's compensation laws of California.
Owner--.....-----•--•.................------.........._..... .... ..Address--..........................
Contractor
ByAgent ................-------------------------------------------Address........................... - ..... - .........