51952 1174 Scotland
Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT C"d
Date V ", 19 6 C Permit No. SI Y,5 2
Application is hereby made for a permit to Q �W -e
a _story, Type-1 Z Building Use Zone
at �7a/ S n7- H Occupancy /
to be occupied only as / �–� M �/ x/x JY°�//M R- , Parking Space 'l–
in accordance with Plans, Specifications and Plot-pl s filed herewith. Fir Sprinkler—.—
Estimated Value of Improvements, $� SO • N
Exemption from requirement for State of California for Contractor's License is hereby c imed by undersigned:
as owner 54, statement filed ❑
Undersigned attests that his State of California Contractor's License
is in fell force and affect 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 manner so as to violate the workmen's compensation laws of California. _
Owner SC •L A ND Address 1179 Q C C2 T L dy n
Address
1174 Scotland ozair Scotland (�
RECORD OF INSPECTION
Foundation 't A 1 • Fume' — Z 3� 7�i,�
$facto Finis 2" 7'-�T .�D�
P4 OZ it o
fcEcK, wAc� p�RNncF
Porn 250.1-10M-5/66 1174 Scotland, ll-25-66, bldg. perm. #51952)