53754 1134 Stafford ?��b �ss
Tract No. J Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT _
Date es �S—, , 1967 Permit No. S 3 JS c id
Application is hereby made for a permit to IV 7-0 dCf'
a story, Type d Buing Use Zone
af� ,J'Tq� /"-,RPO a�''.�sJ•tI��g occupancy
to be occupied only as.r•Mrd•�f /'��i• /+d�'• �(��Pl�arking Space 2
in accordance with Plans, Specifications n�ot-plana led4ere?Fifh Fre Sprinkler
Estimated Value of Improyements, $-;I r_ -u _.
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 # /r�
is in full force and effect and properly.authorizes this application.
7
San Jose City Business License # —/yj-"
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any manger so as io violate th} workman's co parse *on laws of California
Owner /f• • NV�'/ fie•_-?• O"l'.• Address `r �
gy r IV Address 4e.,.6 4. o•G°d'e
99/5—W01—I On .,.A
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