51366 1167 Stafford
Tract No. 3 1:2 9 Lot No.
CITY OF. SAN JOSE BUILDING DEPARTMENT:
APPLICATION FOR BUILDING PERMIT _
Date� 19"_ Permit No. S 3 Co
Application is hereby made for a permit to G-JVf7JPfVGT
story, Type.r/ VL �,�.� 8uildin"g�i� Use Zone B'
at 7�/��;ZTI�p/=tI/l�d�"� /yl/SAN .r�': ' Occupancy
to be occupied only as /�!G_ �O�M / .'/P1J/DE"vGC Parking Space
in accordance with Plans;Specifications and Plotp�laffiled'h�ith.otFire Sprinkler
Estimated Value of Improvements, a7/00
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑
Undersigned attests that his Stateof California Contractor's License #
is in full force and effect and proplyy{uthori:es this application.
San Jose City Business License
I ceriify that in the performance of the worVfor 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.
Address S s4lY xx
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