43212 (2) 7941 Crhhb6i{f �Of,«
CITY OF SAN JOSE �+ BUILDING DEPARTMENT
APPLICATION FOR BUILDINGIERMIT
- -- Tract N��.�.�/---.:. Lot No. T..---------- z
Date/c2/' ........... 19 6....3 Permit No. .J- -Z-------,--
6'�� '
Application is hereby m e for a permit t .........................................------..---........---..----..
a........ ......story, Ty p ..
� : -�'-- ....... — --------. - -Building
Use Zone ------------
at
� ..
Occupancy '!-------------
to
- -
to be occupied only as/.... -----.. . .__._ P r �ce ....mac...---------
in accordance with Plans, Specifications t-pf8elf e
Estimated Value of Improvemenh, .-./ ....� D/
I} is hereby agreed that the requirements of the San Jose Building and Zoning Ordinances and all other
laws applicable to the construction, location, and use of buildings within the City of Sen Jose, will be
complied with,
I certify that in the performance of the work for which this permit is issued I shell not employ any pery
son in any mannedxleeo
• violeI the wor>>kmen's compensation laws of California. /�
Ofner .- � Addres _S
Byw:n ..:r. .,�. :_.G' ------------_Address .-.. . . ...--'- -.._---
Form 380-1
RECORD OF INSPECTION
Foundation Frame
Stucco --------------- - ----------- ........................
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