51757 1117 Stafford
Tract No. �Z � Lot
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT ft�o
Date 10 —31— , 19 S C Permit No. S 7 52
Application is hereb madee,�for a permit to C00W AiiNv r
a story, Type ( BuildingW Use Zone
at Ljr.r Occupancy f
to be occupied only as IN Ll A/r /(fie /!A'°'"_ 'f erking Space
in accordance with Plans, Specifications and Plot plan filed herewith. Fire Sprinkler
Estimated Value of Improvements, $ /r goas.00
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed 1:1t 'Q Q R
Undersigned attests that his State of California Contractor's License # /:J
is in full force and effect and properly authorizes chis appplication.
San Jose City Business License # x;1;4 O
I certify that in the performance of the work for which this permit is issued I shell not employ any person
in any man er as to violate the orkmen's compensation laws of California.
Owner �VWfV#��CS� •��CAddressl�7s�`S Nwy S S q
gy Address _GAIL 41 A03ioVt
99/5—W01—I On w,ai
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