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Tract No. ✓ 1 Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT�!,rv'^''`"
Date 19 6-7 Permit No. B
Application is hereby made for a permit to Coa�ST/?vGi
I . l story, TType_ 1L Build ingg Use Zone
at 112-f YC 6 �G�ti""�7�-�Ci7 GC%�� Occupancy
to be occupied only asParking-Space
in accordance with Plans, Specifications and Plor�a�
ld heVVWKEW Sgrinkler
UPJ
Estimated Value of Improvements, $ /./
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑ 1'3-1
3 _/ _ / f.3
Undersigned attests that his State of California Contractor's License �'.
is in full force and effect and properly
authorizes this application.
San Jose City Business License
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 to 'violet the work-on'pensation laws of California.
Ow,,�r�er
s - Address 1123-1 'y %
Byh.�, 1416t" - l/� Address/
99/5 — W01 — I�Gsz
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