52984 (2) 1119 Elmsford 2.v0e-
Tract .No. Z Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date '7 19- •Permit
Application is hereb made for a permit to 136'14>
a story, Type Building Use Zone/-1_BIL
at £ M ��C/ Occupancy :r_
be occupied only a �/��,�Pa i Spacey_
// k/ re Sprinkler
in accordance with Plans, Specifications an` o+-plan file erewi+ .
Estimated Value of Improvements, $P[ UVy -
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑ #L3-1- ley
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 # q—IG vj
I certify that in the performance of the work far which this permit is issued I shall not employ any person
in any man er so as to viol to th wcYkr eos c pensation laws of California.
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