40212 (2) CITY OF SAN JOSEC BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
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Date.//. ................................... 19zp.. � r�^'+ No.-.../..--0- ^./-.^---
Application is hereby made for a permit A.../............. .....:............................I................. .
a----f"_--story, T ped-------/. . -- -- .'. /U ---........._..._..._.--------- -. Building
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SC lECa2 ��:.- -----------
Occupancy
� . Use Zone -- -----
a+,l/�.. .. .... . . .�.. --
�// / Y Occupancy .. .r.-----.....---
to be occupied only as ._..........�.�... AIC �- Parking Space ....I...............
in accordance with Plans, Specifications and Plof-plan filed hgrewith.
Estimated Value of Improvements,P 3 .. .....
It is hereby agreed that the requirements of the,Son Jose 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-r3ann r s Vas violate f workman's compensation laws of California.
Own / 9c "`.: Address/ � :--V--r.. .... ._.
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oniracto
Byna'�J.'r' ""�i��/�.!!-L''-----Address �,�.,:. ...-:...>._ --------
Form
- -.Form seo-I 1165 Crestline Dr. R.J. Hu er & Assoc.
/RECORD OF INSPECTION
Foundation .._
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Stucco -------------------- -
-- - ..... --- -"- - - Finish