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Tract No. T j 2 j< Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT °�eG
Date 71--
2 r: , 19" Permit No.
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Application is hereby made for a permit to
a� story, Type BA Use Use Zone_R 6 6
Zone-
at �J5�9 Yom tF1/RF '� So LAA/ "Oc�cup�ncy_��
to be occupied only as _/ fA�.l , `� 9 ScD-aj' )lark giSp_9ce
in accordance with Plans, Specificatins and Plo+-plan f led herewith. Fire Sprinkler
o
Estimated Value of Improvements,
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner E!i�' statement filed ❑
Undersigned attests that his State of California Contractor's License # 5:
is in full force and effect and properly,90hori:es this application.
San Jose City Business License # !�7—
I certify that in the performance of the work for which this permit is issued I shall not employ any parson
in any manner so as to violate the workmen's compensation laws of California. /
Owner uT�'!iY �- �e /^YAddress'
By _ Address
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