52758 (2) 1161 Crestline
Tract No. Lot No.
CITY OF SAN JOSE I BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date 3 — /S , 19 6 7 !• Permit No. 37Z- 76-,j
Application is hereby made for a permit toasxU
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e '' •T Story, Type in9.;,., Use Zone Jq I•V3
of ///�/ r' J Occupancy_
to be occupied only as '/ "r Parking,Space Z
in accordance with Plans, Specp an n i pKiith. Fire Sprinkler
Estimated Value of Improvements, $
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner K statement filed ❑
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 violate the workmen's compensation laws of California.
Owner or✓/x� S 621En/S/CZ Address //6/
By +� dJ1 C, Address //Z� !/ 016aSTi- ry£ D/L S
1161 Crestline Donald Schemenske �—
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