30504 (2) gTY OF SAN OSE, BUILDING DEPARTMENT
AP/PLICATION FO BUILDING PERMIT
Date--------------/- ...... 19 �--
/ �-- ------... ....... ...................
Application is hereby made for a�t 'to-.-. . .
a---------- -- sto y. TY - ....... .... ....... ...---------------------- -- ---------Building
at. ¢r
-------------- .tea-- .�. ��.-�.'A-- -------- ----- -----------
to be occupied only as.... --- --- ---- ----GCN" -- --- -- -- ---------
in accordance with Plans, p cjficafions and Plof-plan wr4
Estimated Value of Impr yeen#s, $- -/
It is hereby agreed that t e ra uirem sof e o ilding and Zoning Ordinances and all other
laws applicable to the cons uction, to ' n, n use f dings within the City of San,Jose, will be com-
plied with.
I certify that in the perfo an of the work for hich this permit is issued I shall not employanyper-
son in any nner so as to come subject to the w kmen's compensation laws
�of�California.
� /�jJ
Owner- - ... - . ....... . .. .....Address-/ve-.7(.!✓�(! errrrc -----! )c
BY------ Id. L -' -�r`�'y-..Address---------------------------------------------------------------
Contracts,
---------------------- ~-----
Contractor, Agent
Form 280-I '
845 Lonna Loma verde Const.
/ RECORD OF INSPECTION
Foundation--� �ly d'' ?.---.--- FFe-r-U - / -----A ---------------
Stucco.....
-------------Stucco..--- ...:------------------`- --------------------Finish.-. lE
.............................................................
P 3 J-/