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—CITY"'OF-SAN`JOSE"----- +BUILDING DEPARTMENT
?LT 12Z APPLICATION FOR BUILDING PERMIT
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Date..... ....... ............._----195--- Permit No.... ............
Application is hereby made for a permit to.........htt=lo.
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a------a"--`''------story, Type----------`- --- = "-- ... ------------------------------------Building
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re r..�ct...ao.... 53 �.................................................
to be occupied only as.......WIE. -�----.-------I dti---- fI . .....................
in accordance with Plans, Specifications an Plot-plan filed herewith.
Estimated Value of Improvements, $.f ..........
It is hereby agreed that the requirements of the Sen 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 com-
plied 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 mahner so as to become subject to the workmen's compensation laws
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of aCalifornia.
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Contractoq~Agent
Form 280-I
RECORD-OF- INSPECTION"`""^ - rc--
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