36167 (2) 1057 'Ctttlbhy Hills
CITY OF SAN JOSE '. BUILDING DEPARTMENT
APPLICATION., FOR BUILDING PERMIT
Date--------- �r/ lqe� Permit ----------
.
..........
Application is hereby made for a p rmit 0 1- ----------------------------------------------
e
a-----/--------story, Type. ............................. Building
at 7.....Ce 40?��...///Az
to be occupied only as .....
in accordance with Plans, Specifications and Plot-plan fili8d
0 .
Estimated Value of Improvements, $.... --—e---.
I
-----
It is hereby agreed that the requirements of the San Jose Buildingand 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 01#6 the workmen's compensation laws of California
Owner 6�WAciclress ------------
114 ------
...............
By ------------------------------------------------------------/-----...Address --------------- .-......--f-....---- ----- -.
or.
5orm.280-1 105�`Codr&ToyanftiL LS Manuel ViLlarreaL
RECORD OF INSPECTION
Founds+ion
S+ucco �4 ..0 -Z -� Finish - —G/