54920 (2) X7,597 Prospect
Tract Noys/ Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date , 19 ( 7 �er ' No.
Appli ation is hereby ma for a permit to--
a story, Type "1 Use Zone
at S 7� m r `C// /(/V(/ 19 I'd
Occupancy
to be occupied only as / ' ���7�'>• Parking Space Z
A q Fire Sprinkler
in accordance with Plans, Specifications and Plot�� cl e � p �
Estimated Value of Improvements,
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑
Undersigned attests that his Slate of California Contractor's License / G�
is in full force and effect and properlyaul � th pp'ca�jon.
San Jose City Business License # �j
I certify t t in erfo mance of the work for which this permit is issued I shall not employ any person
in any nn x a to vi ato t�workmen's compensation laws of California.
OwlA//Pr�A2r�ess
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