52653 1159 Stafford
Tract No. 312 s/ Lot No, tl '
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT '
Date Z " Zt 1907 _Permit No.-,� C6-3:4✓d
Application is hereby made for a permit to w f 4•w
a story, Type ' X4–/ � g Use Zone.n_t.p_6—
at / f J7018 r f� Occupancy _
to be occupied only as .SINE/I /rNMi[y Q6S• Parking Space
v Fire Sprinkler
in accordance with Plans, Specifications 13.0 o+-plan file�dr�herewith�-
P S U ca /r/� 67 ,D
Estimated Value of Im Improvements, � d a!
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner r7 statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly`authorixes +histapplication.-
San Jose City Business License # —/ —to
:y4
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 4o .iolate the workmen's compensation laws of California.
Owner •T' H'/'✓lEK Acroc.rvG. Address if 7•f S. ff�11Y f 'S9N rT✓l6
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