52984 (2) 1143 Elmsford
Tract No.j Lot No. 3 A
CITY OF SAN JOSE BUILDING DEPARTMENT
A PLICATION FOR BUILDING PERMIT
Date `3- 27–'0 /' 19_ , Permit No. Ar �'-v✓
Application is hereby made for a permit to �f LO
a story, Type Use Zone/_B6
at Occupancy_�—
to be occupied only as S/�'ez /" ;L /?cs, Parking Space 2
in accordance with Plans, Specifications and I glanPV ithFire Sprinkler
Estimated Value of Improvements, e
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑ ��_ J
Undersigned attests that his State of California Contractor's License # 13- 1
! 7
is in full force and effect and properly authorises this application.
4—/d S���
San Jose City Business License # / -
I certify that in the performance of the work for which this permit is issued I shell not employ any person
in any manner
so as to y}folate the workmen's compensation laws of CaIifornieL/ � �
Own r / t a"/z �' Address �7b–f
By �i)tin 'YJ. ,�cty.2r,{L, Address
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