52904 (2) 1139 Elmsford j q 3ooc
Tract No. e+ �' L Lot No. 3 /
CITY OF SAN JOSE BUILDING DEPARTMENT
q APPLICATION JQR BUILDING PERMIT
Date J tel?' , 19_7 Permit No..,5-Z Qty u�✓
/pplication is hereby made for a permit to � y 4) �� pp
a story, Type Buildi gam , Use ZoneJ_�l..u_b
at I/J f E�A(S/%ur A Q4• /�(�(/ Occupancy_V
to be occupied only as •T Ne4c . /�f$- Parking Space Z
Ian filedherew th Fire Sprinkler
in accordance with Plans, Specifications sand I�Y ���
Estimated Value of Improvements, $
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License # J 7 7
is in full force and effect and properlyauthorizes this application.
San Jose City Business License #__/ _ 16•f yy
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 to violate th% workmen's compensation laws of Califor�, C S.
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Owner •f' Pf viiiimK /9S.tca. �~!•Address 7� 7 J
By 7N Address fAmf 'AS
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99/5—W01—I-09Z .,.I
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