33039 (2) ALOT.....Y.-9.........WESTLYN #2 TRACT 2168
CITY OF SAN JOSE BUILDING DEPARTMENT
4PPLICATION FOR BUILDING PERMIT I
4v 6) __.1U.a5f..............
Dat ....
... ... ..
................. ... 19------------ Permit No.
Application is hereby made for a permit to------PMST.RY.C.T-------------------------------- ................
a....... .....story, Type------ -.RES......-------------...---
Y**-"**- Building
..... ..............................
at...... .... ...................................I..................---
to
.............................I....................to be occupied only as-811lGi., AWLY RESIDENCE .....................................I...........
...................... ........
in accordance with Plans, Specificatic; ......
Estimated Value of improvements, 10.0..........
It 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 San Jose, will be com-
plied with.
I certify that in the parfqrmance of the work for which this permit is issued I shall not employ any per-
son in any manner so as to become subject to the workmen's compensation laws of ari ornia.
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..................... Address--... ....................A - ---- ..................... -------------
ddress------- -— ----- --- -------- ----
By--- ........ .......... ---------
Form 28D.1 Contractor. A ant
RECORD OF INSPECTION (�
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