35686 1130 St62Olddhd 84, 7-
CITY OF SAN JOSE &4,Y Af BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date---------'--------------------------------------- 19-----61-.. Permit No. S -----------
Application is hereby made for a permit to ..... -------------------------------------------------
a---------l------story, Type.-...0........ ------ -- ----- - ---,W- -------------------- - Building
at ------ke...... 1116 4 v
A14163
to be occupied only as ---1.7nlc;:
in accordance with Plans. Specifications and Plot-plan filed herewith.
Estimated Value of Improvements, $------ ----------------
It is hereby agreed that the requirements of the San Jose Building and Zoning Ordinances and all other
laws applicable to the construction, location, and use of buildings within the City of San Jose, will be
complied with.
I certify that in the performance of the work for which this permit is issued I shall not employ any per.
son in any manner so_as to violate the workman's compensation laws of California.
Owner G......Address --- ------
ILI,
B ---Address -:�Fcz.,es..71.4.e--------------------------------------
. ... ...............
Contra,et6, Agent
Form 280-1
RECORD OF INSPECTION
5l�-Gi �.�
Foundation - -- --...----- ------- -------- Frame .... .... �!�--'o --
Stucco/ ....... .......... ..�..'�-- ----- Fini .-- --- --/----------------