36160 (2) BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date----- -- - 19-61--- Permit --
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-SI-26--------------- --------
Application is hereby made for a permit to 25-h/...._------------------------------------------- ------
a---------/------story, Typci�]�------ - - ------------------------ ---- Building
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at ------- -A/�,,',A, - ----- --- - -----
772, 3
to be occupied only as ...zk-- . .........W
ot.,
in accordance with Plans, Specifications an ot-plan filed herewith.
Estimated Value of Improvements, $...../6.1AV- ---- .......
It is hereby agreed that the requirements of the Sam 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 workmen's compensation laws of California.
S64L-..........Address ./,/ -
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Owne(r:�Pp�J�14��-Ia
d . 1 '2 -:7- -------------------------------------------
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By
Contractor, Agent
Form 280.1
RECORD OF INSPECTION
Foundationprame e�'R7---.1_2--.-.. - -----
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Stucco ------ Fin
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