52102 7628 Shadow Hill
Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
J APPLICATION F RQ BUILDING PERMIT FEf-
Date /1 —/� , 19 ( l Permit No. 5—e-16 Z
Application is here made for a permit to, - P cop
a/story, Type G se Zone I?
at 7c,-, Z L Occupancy f
to be occupied only as nar �
in accordance with Plans, Specifications and Plot- fifb arewiffi.l "' `r""K'�-'—
Estimated Value of Improvements, $
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned;
as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes this application// I
San Jose City Business License # Gr
I certify that in the performance of the work for which this permit is issued I shall rot employ any person
in any manner o as to violate the workmen's compensation laws of Californ ie. ..
Own Adc.ress
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