37597 5� �i1 idA k J. thihbAhe & A&s bo
CITY OF SAN JOSE ,
?L,4/�, BI�ILDING DEPARTMENT
APPLICATION "Fidlit BUILDING PERMIT
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Dafe./Z - L L-
- 19 (�� Permj+ No.- -75 `LZ.............
Application is hereby made for a permit f9
a------/----story, .... . ...... ...._�P!xfU-..--------.....-------.. Building
to be occupied only ash
in accordance with Plans, Specifications and Plot-plan filed herewith.
Estimated Value of Improvements,
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 anymannsoyas to violate
etthe workmen's compensation/laws of Californ' .
Owner / //�(. 1 1� v(GL e.( ddresr/ c�In -� -- ,Gtl Q .
/////,� - - -- -
/ Address /
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BContractor, ant
Form 280-1 ` -
"RECORD OF INSPECTION
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