51366 (2) 1163 Stafford
Tract No. 3/2 6 Lot No. %r
CITY OF'SAN JOSE BUILDING DEPARTMENT
Q ,t APPLICATION 'FQR BUILDING PERMIT F�
Date _�T 191 /� Permit No. f �7
Application is hereby made for a permit to ( 0^ur*?VcT
a_/�story, Type A V i/ Building. �) Use Zone(
at / S gCf4o � (/ Occupancy
to be occupied only asS/NW Parking Space
i_n accordance with Plans, Specifications planyfil�� +hFire Sprinkler
0111
Estimated Value of Improvemenh, $
SOO:dO •2eA e:0.,
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑ �43f6�_/ /
n_
Undersigned attests that his State of California Contractor's License # 7 V_
is in full force and effect and properl authorixes�tyhis application.
San Jose City Business License # —Ia ;STB
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 io violate }h workman's•compensation laws of California.
Own/er� rr t/NIrII /4 SK. /mit Address 1125 Ao y q,
A� r,
By " Address „(IlVMl AJ �W�byl
99/5—W01—I On w'ad
72
b P' 7 o!}epuno j
N01103dSN1 10 08003b