04552 F (2) ' =
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Tractact No.No. .3%�) Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Dale %— /8
. 11977 Permit No.
Application is hereby made for a permit to
a story,Type Lfse Zone
at 14,?g Occupancy
to be occuoie only as—P✓14Sq,feet
in accordance with Plans,Specificand PI PI e
� 1 ll Jlere ith, Parking Space
Estimated Value of ImprovemenFire Sprinkler
Enter. Elect.
I certify that in the performance of the work for which this permit is issued 1 shall not employ any person
in any manner so as to violate the workmen's compensation laws of California. y—
Owner 4 Address X49 or
By L � Address/419y ,� i.•.
-Ao ."rens i003 dd
/Oa3
This permit shall expire and become null and void if the work authorized by it is not commenced within
120 days from the date issued or if the work is suspended or abandoned for a period of 120 days after
commencement,
FINAL INSPECTION 260-601 N
4)9;(O 4.4 4 -79 57.4' ---
Exam tionfrom
p requirement for State of California for Contractor's license is hereby claimed 6y applicant.
as owner ❑ � statement filed ❑
Applicant attests that his State of California Contractor's License No.
is in full force,md effect and properly authorizes this application.
San Jose City Business License No.
I
I
• . 14 T
1.OCATION / (/D 2. DATE RCD. 3.TIME RCD.
- .7
• 4.READY ( 1 ANYTIME ( 1 5.TYPE OF 6.AREA 7. I SPT.MADE—
PM ( I SPECIFY INS C a TIME j/ 0.11
L DAT
• 8.APPROVED ( I 9. ARK : r
DISAPPROVED v S N
® INSPECTOR ,/aiyY
280-671
WHITE-FILE YELLOW-INSPECTOR PINK-OFFICE