31276 (2) 856M
CITY OF SAN JOSE 4eL14--7,1-. .-, •BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT F-D�
Date--------- -------------------- 19 p it .................
Application is hereby made for a permit to.... . . -----I.................... .......................
a_........../'----story, Type--- ----------------------------- - . ....... .......................Building
at----.......... ............. .......... .... . ------------------
to be occupied only as---- --- ----- ...........................................................
in accordance with Plans, Specifications and Vfn file
Estimated Value of Improvements, $
*
It is hereby agreed that the requirementsof4he 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
any m nar so as to become subject to the workmen's compensation laws of California.
0W"r___
C � 01f
By.... dress-----------------------------------------------------------------
Contractor, Agent
Form 280-1 856 Grimm Loma Verde
RECORD OF INSPECTION
Foundation. -
.............................................. Fra .........
sfucM.....................-------------------------------------------Finish-------
. 46
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