30838 (2) CITY OF SAN JOSE BUILDING DEPARTMENT
i
APPLICATION FORK
OR BUILDING PERMIT $o4
Date.............. . _ CR--—----.............195__�.. 1313S Permit No.
Appic8lion is hereby made for a permit to............. ...................
:t.....
. ..... ...................Building
4 r
............................ .6..
......fory, Type
to be occupied only as.-----1 .....
. .. 1'r0 W4a*11
in accordance with Plans, Specifications and Plof-plan filed herewith.
Estimated Value of Improvements, $---
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 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 in an manner so as/to- become subject to the workmen's compen�sati 5 lifor ia. .Al?i oe
t%.�. .........Addreis.//2 -- -------
Owner ...............
.......Address....................................................................
Contractor. Agent
Form 's"837 Grimm 6_/, Loma Verde Const.
RECORD OF INSPECTION
Foundafion........
.................................... ..........--Fra .............................--------------------------------------
Stucco.---------------------------------.......................................Finish-------
.....................................................
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