30504 (2) 8,3 Loma
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION F BUILDING PERMIT rO
Date------ Z�4 ...._----- 19-- Permit No----------i=0.X64-----------
Application is hereby ma a for a p4'ii to..... ..............................................
s ---------*;l Building
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to be occupied only as......4 -- - --I
-- - - ------------ ...... .... .. . ...... .........
in accordance with Plans, Sp cations and Plot-p i ed herewith.
Estimated Value of Improv ent $ /Z-- --------- - -----
It is hereby agreed that the require ants f A J in and oning Ordinances and all other
laws applicable to the constru ion, locati , an use of u dings within the City of San Jose, will be com-
plied with.
I certify that in the perform nce o a work for whi h t is permit is issued I shall not employ any per-
son in any anner so as to Loco ubloct to the vfhorkm n's compensation laws of California.
Owner. .- - - - --7 h..(�aIPTAdd --- ---I -- ------- -------- -- -------- ......
By....... .... - ... .........Address.--... ----------------------------------------------------------
ont actor. Agekt
Form 2BO-1 853 Loma Lorna Verde Const.
RECORD OF INSPECTION
rAfel, ..............
Foundation_. r. ....C'----I--------- ---- --- ---
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