52653 (2) 1155 Stafford
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Trac+ No. .71_` Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date 2-Z1f • , 19 LZrr�� Permit No. TZ6S 3 --44; y
Application is hereby made for a permit to 130" /?
a_story, Type, A✓ uili iinng� Use Zone R�
at/1iS STJ4Ff 2� � a.'�C.I/� Occupancy_
to 6e occupied only asyj2!r P/[ 'Parking Space Z
in accordance with Plans, Specifications anandPlot-pla�f d he;ew,/�+I
Estimated Value of Improvements, $2f pOJ. ru
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑ //QQ
Undersigned attests that his State of California Contractor's License # s✓
is in full force and effect and properly authorixas }his papplication.
San Jose City Business License #� —/�•r1
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 theworkmen's compensation laws of California. r9�, TS
BOwneT_ r /� N d ASS4e . X OCAddress //ACS-N6.r ?[ • J �L
/►ARIL • Y•�. Address 3AAfi 018 Ado-1z.
99/9—W01—1-08Z w,oj
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