5839 (2) 1149 Derbyshire -e=
Tract No. Lot No.
CITY OF SAN JOSE BUILDING. DEPARTMENT
APPLICATION FOR BUILDING PERMIT ;'"'Y3 '
Date / 3 .1i9 7 ? !Pfermij No. sle �9
Application is hereby made for a permit to
Ja story,Type Buil=g4297 0 Use Zo' —t
CI at s r, Occupancy
to be occupied only as Sq.feet
in accordance with Plans,Specifica[io and Plot•plan filed herewith. Parking Space
Estimated Value of Improvements, $ ,Z O C) Fire Sprinkler
mer. Elect.
I certify that in the performance of the wor c for which this permit is iss I shall not employ any person
in any manner so as to violate the workmen's compensation laws of California.
Owner Address y By _ Address 7
This permit shell expire and become null and void if the work authorized by it is not commenced within
120 days from the date issued or if the work is suspended or abandoned for a period of 120 days after
commencement, r
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