43123 (2) 106
CITY OF SAN JOSE i �"� BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
j /`< Tract No.�.l 4y`.y.�.. Lot No.//- /--------- i
Date/0- ...... -....... 19.Z_ :1 Permit No.... ---
Application is hereby ma4e for a permit to" ..........._......................
a---.--,1---.---story, Ty 8--------, ................... .. ..----._... ...-.. Building
�0 3 0 R.L- 94---
at . ............... o.--......--- "- - - - ------------
to be occupied only as /.. .. . ..........ri?..... Parking Space .........2.....,....
in accordance with Plans Specificat'o d o - Ian file herewith.
Estimated Value of Impr vem _41--- -------------------
It is hereby agreed that the requirements of the Sen se 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 as to violate the workmen's compensation laws of
Califo�rnia,k�
Own rsAddress
.r.. I, o _ Lu a�
/
- .Address:_ -----
. ----- -
... . ------
.......
Form 280-1-1
RECORD OF INSPECTION
Foundation 1.:�r=.(<�L h-_-.--- . Frame
Stucco ---------------: - ---- ---....--- ----- C Finish
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