53754 1130 Stafford �m
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Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
_ APPLICATION FOR BUILDING PERMIT
Date ,j .:- , 190 Permit No.-JL-3—2ry.e..,1
Application is here made for a permit to C , V r-VC e , Q
a story, TypeBuilding Use Zone��.B
at V S r4f--)e 40?a-�24- T. Occupancy y
to be occupied only as Xoee-lt cAyqParking Space a
rFire Sprinkler
in accordance with Plans, Specifications and Plot-plan filed herewifh.
Estimated Value of Improvements, $ ;�V/ 6d0
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑ �� 1 I g 96
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes,�gqchis application.
San Jose City Business License #.4-1 VST B
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 viollaatef}�a workmen's compensation laws of California. V.Owner trTc��ppa'wLe'vsr'C"Pgpp' AMS ' Address ���.f�'s �� 7
By�sYY 1(r(tue..Qa+'.� !� �' Address
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