53549 313 ,
1158 Stafford C �
Tract No. L�' Lot No. G /
CITY OF SAN JOSE BUILDING DEPARTMENT
tt APPLICATION FOR BUILDING PERMIT _
DateJ �b� 19 G7 Permit No. s 3 S r{ 9
Application is hereb made for a permit toC000e70d T
at 11, story, Type Building Use Zone —v
Occupancy,
to be occupied only as ,� Parking Space 2
in accordance with Plans, Specifi ations and Plot-pl ledrhereWr� kler
Estimated Value of Improvements, $ G.1 46/
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 thisrapplication.
San Jose City Business License #--(t—�4`1
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any man r as to violate a we kmen's comp sation laws of California.
Ownea/S ddress //7s S/�Q" �^
By b, �r Address/J�1dh
99/5—W01—I-09Z wioj
ysiu! 000n+S
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