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CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FO BUILDING PERMITt
4rIc--5-4'Permit No---- .........
Date--------I -----------------------------195 ... .
Applic./�rY 7ermit
is hereby made for a p to..... .. ... ........... ............................
-------/-----------story, Type... =- --------------- ---- ------------------------------------------Building
t_................ ------------
AI----------- ....... ----- --- --------------------------------
LJ
--------- .......
to be occupied only as.------/.. ..... . .......
in
s-------/.-
in accordance with Plans, Specifications an 6f.pl n fil here if
Estimated Value of improvements. $...
It is -hereby agreed that the requirement, of the San Jose Building and Zoning Ordinances and all other
laws applicable to the construction, location, and use of buildings within the City of San Jose, will be com-
plied with.
I certify that in the performance of the work for which this permit is issued I shall not employ any per-
son t to the workman's compensation laws f Cal'form .
son in any annor so as f 60C 0 su 11 c
OZ W" . . ....
I ... -1 _4,sj)Address./'Y'r'../._ . ..... ... . ...
Owner.
...............
-------------- ------------------
By-------- ...Address......
7in_ I
Contractor, Agent Loma Verde Const.
Form 2BO-17584 Erin b /_ ',_4
RECORD OF INSPECTION
Foundation...... ---.......Fra
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Stucco------...---------------------- ...........!9<nish-----
5- 4(00 s/,:r
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