53612 (2) 7585 Prospect
Tract No.�L Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date S/& - , 19 G 77 Permit. No. 3 (, /,25(
Application is hereby made for a permit to Cu v5T Pool
a I story, Type Building Use Zone ��
ar p Occupancy
to be occupied only az — v � � �Pr�rkir�g�pace
in accordance with Plans, Specifications and Plotplanrf_ilad he �rF-1LSprinkler
$ ! � .
Estimated Value of improvements, u✓ �
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes this application.
San Jose City Business License # y '/ SV&' '
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any manner so as to violate the workmen's compensation laws of California.
Owner J. ✓NT£K f /WSJ ac. .J-.•'c Address f' �f"' `/
By �� --� -- L 1_'_ �iz. (/•/° Address
WS—woi—i-oez w+aa
zM v �.�, .� � uoi{epuno j
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