52469 (2) 1128 Elmsford
Tract No. /2ll� Lot No.��
CITY OF SAN JOSE BUILDING DEP• JITMENT
APPLICATION FO•� u
BUILDING PERMIT .Ypf�
Date_(-' 19 G / permif No.,J�2 44W
Application is hereto-made for a permit to N/LD•
a stor/y, Type `r" Building Use Zone_`
V• Occupancy L
to be occupied only a P • Parking Space 2
in accordance with Plans, Sp cificati s and Plot- Ian filed herewith. Fire Sprinkler
Estimated Value of Improvements
Exemption from requirement for State of California for Contractor's-Cicense is hereby claimed by undersigned:
as owner ❑ statement filed El '�`I
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-�"�
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any manner
so�as�t�o�violate ha orkmen's compensation laws of,California. r
Owner
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