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CI Y OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Dafe__/,z/ ,�--------------------------- 1902 ---- Permit No. ....................
Application is her!"ade for a permit fo�Z,45:�2
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to be occupied only
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in accordance with Plans, Specifications and Plot-plan filed herewith.
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Estimated Value of Improvements, $ /_J-_..:-------- '
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 i(to violate the workmen's compensation laws of Califoyni,
Own,4r IAdd ress ........ V.... .... ---
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..................Address,,.-4--- -------------------------------------------------
By -------- -
Confractor�fAgent
Form 280-1
RECORD OF INSPECTION
Found
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