37797 7623 !Wq rWod
CITY OF SAN JOSE �q� BUILDING DEPARTMENT
f APPLICATION FOR BUILDING PERMIT
Da#e.L./-----------------------------., 19. ../ ��f�Permi+ No.-- -..............
Application is hereby ade�r i permi+ +V:; . .:................._...._--..._-------------- .........
a.....----f-----story, Type-(15.. .r.. ..-�-'-`----- -----'----C,-y-------------------------------- Building
to be occupied only as - `. ..------..
_ a i
in accordance with Plans, Specifications and Plotle erer�flS! Y -
• �r
Estimated Value of Improvements, $../..:/`r�....................
If 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 as to violate the workmen's compensation laws of California.
Own T .... - ....'- - ..Address -----
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By -C--------------------------Address
60 CoAgent 1
Form 280-1 _ -
RECORD OF INSPECTION
Foundation Frame ----- --- ----
sfucco --------------- - C
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