52653 (2) 1149 Stafford �j 3o�D•
Tract No.✓ 1L6 Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT �q"� "�
Date 2 '2• � — , 19 G7 ,Permit No. 5—Z 6S__3_�rgs.L"
Application is hereby made, fora permit to
a _story, Type �,��' Building`'✓C/r Use Zone_.�_(_�
s at /��4 STAFr=o neo 1p .S• ` Occupancy
to be occupied only as Xh ,� , Parking Space 2
in accordance with Plans, Specifications and Plot-planfiled herewiith. Fire Sprinkler
Estimated Value of Improvements, $ -2y, Ois'9. o V
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 r 4
is in full force and effect and properly authorizesthis apeplication.
San Jose City Business License $k A4 �� V A '
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. 7-
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