52469 (2) 1112 Elmsford
r Tract No,?/2 G Lot No.o2oG
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT �161f�
Date Fr,6• , 1967 Permit No. ,'S-2-' 6/
f Application is hereby made for a permit to 1pU] ki-P•
a 2 . }' fory, Type 3 Building Use Zone R-I
A L
'80-4M Fa IP ✓1• `rAT. Occupancy_
to IoCoccupied only as N //!/V Parking Space Z
in accordance with Plans, Specifica#i ns and Ploft Ian filed he ewith Sprinkler
Estimated Value of Improvements, $ 12
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑ �3^, y 3y��
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly a tkori:�fti s pplication.
San ,Jose City Business License # (� TO
I certify that in the performance of the work for which this permit is issued I shall not employ any person
inany manner so as to violate the workmen's compensation laws of California.
Owner ✓n/f£Q /�SSUG.�ACAddress I/7S—,�' Ht✓�/ 2- `S• T
ByeV-10 Address 101l ^Q ^14'0'e '
W01—I-08Z ""°d
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