51600 1168 Scotland
Tract No. 3c' Zp Lot No.' 1.7
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Dafe o f& 19A66P mi '�t No. C�
Application is hereby made for a permit to
astory, Typ ildin Use Zone
at /(/(/ Occupancy
to be occupied only as/7-- Parking Space
in accordance with Plans, Specifications and Plo la filed herewith. Fire Sprinkler
Estimated Value of Improvements, '
re yJ� aimed by undersigned:
Exemption from requirement for State of Carnia for Contractor's License is horab
as owner ie statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes this application.
San Jose City Business License #
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any manna o s to violayte�t�h.ess w rkman o sation laws of California.
Owner�� Address 116?f60 (/j' r"Z
By Address
1168 Scotland Robert M. Wialbut
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