33799 8$4 §t6fti'n8
CITY OF SAN JOSE ���. BUILDING DEPARTMENT
APPLICATION /FOR BUILDING PERMITr/PPaxSa�
Date....... / 19-(C o Permit o.--�... 1=/ �---------
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Appli ation is hereby made for a permit to .I.J ............................................
a--------- '----story, Type--- ---------------------------------------------------------------- Building
at .........
to -- 5-r .
to be occupied only as "...... . . . .. . .... _
in accordance with Plans, Specifications and of an
Estimated Value of Improvements, $._1. -------•
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 es fo viol }e the workman's compensation laws
ssofof California.
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Owner ---...".�`-�..- ...... . . -
Address .U../-..S�IGUG!!-----
ti
' _ -�' .Address - - - -
854 c9tAlf1°k° t Palo Alto Dev.
Form 280-I _ '
RECORD OF INSPECTION n
Foundafion 7�1..:E!rC.42zP� Frame F 3/—C�d /✓ ���yyc�
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