39381 (2) 7011 F611
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date---------------0...C,-�------Zo.......... 19..�./.... Permit ---------------------
Application is hereby made for a permit to ------------ -NSTRUDT--------------------------------------
a------/------story, Type------ ------ --------------------------------------- Building
at ----79za------- OT AUTUMN GARDEN #2
TRACT 2813
to be occupied only as S1NGH-FA'M-T1LJF.A //�*�T;
in accordance with Plans, Specifications and Plof-plan filed herewith.
Estimated Value of Improvements,
---------------- PL-4N 3/Z
It is hereby agreed that the requirements 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
complied with.
I certify that in the performance of the work for which this permit is issued I shall not employ any per.
son in any manner so as to violate the workman's compensation laws of California.
1 1300 El Camino Real
Owner ..............CIIAAD!_TAIR�MIN�................Address ------MenjoF-PaA----California....
By 49
rJ --------------------------------
, C-�� ::f4oel- ---frurgeAddress ----------DA%vienPort 1-7070
C r Af��).
Form 280.,I Contractor,or,. gon project Manager
n RECORD OF INSPECTION
Frame ....--
Finish ------- --- j-