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52653 1149 Stafford �j 3o�D• Tract No.✓ 1L6 Lot No. CITY OF SAN JOSE BUILDING DEPARTMENT APPLICATION FOR BUILDING PERMIT �q"� "� Date 2 '2• � — , 19 G7 ,Permit No. 5—Z 6S__3_�rgs.L" Application is hereby made, fora permit to a _story, Type �,��' Building`'✓C/r Use Zone_.�_(_� s at /��4 STAFr=o neo 1p .S• ` Occupancy to be occupied only as Xh ,� , Parking Space 2 in accordance with Plans, Specifications and Plot-planfiled herewiith. Fire Sprinkler Estimated Value of Improvements, $ -2y, Ois'9. o V 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 4 is in full force and effect and properly authorizesthis apeplication. San Jose City Business License $k A4 �� V A ' 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 workmen's compensation laws of California. 7- Ow er " y,�/TSoO i �Se1 •=~Address —S ywy �/ 'Vyyf� �C�. V• - Address.ShAll /93 �1/)v✓E 99/5-W01-1-08Z —01 000n}S ewa j � uo!}epuno j N0II03JSNI d0 480038