52653 1143 Stafford "� 3p0
Tract No.V r -6 Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date 2 1Y — , 19LLPermit No. CZZ (-L3 �.i d
Application is herele made for a permit to Oyi"
astory, Type B Building � Use Zone-R��
at ��WS .S f�?tr - of 4,� K�/° .t 2;ve? Occupancy F
F
to be occupied only as.s/A'm'fe At. /CSS - Parking Space__
in accordance with Plans, Specifications and Plot-plan filed herawith��V I Sprinkler
I I / ;/ / V�
Estimated Value of Improvements, $2or e,"A AP
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 aypplication.
San Jose City Business License #--it—to —
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 violate the vforkmen's compensation laws of California.
Owner_ f�rJN� 0f 4S Sye.gq,>;ddress 1fu 3'NWy s' T
gym ffi. V'/�• Address LL---e-C__�0'**
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