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CITY75F SAN JOSE ��Ay . BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIITT 2—//Y.9
Date- 19.CZ-..Z Permit No.rZt.-..V....
Application is hereby Jmade for apermit t -------------------------------
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a - --------------------- --------------------------- Building
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to be occupied only as .......... .------..T..--.-s-- �['e
in accordance with Plans, Specifications and I -plan ed erewi
Estimated Value of Improvements, $,,l/-.-
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 t,e performance of the work for which this permit is issued I shall not employ any per-
i
son in any manner o as to rsous: th workme/n's compensation laws o a i orn� G
Owner . ._ ku. �j.. ' ' /C�_.`..............- ' .. -4--L- � ----
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B/ ... .. Address. .._/ cff
Contra Agent
Form 280.1
RECORD OF. INSPECTION
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