51359 (2) 1074 Stelling
Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date 9/-z 0 19G6, Permit No. S �
Application is hereby made for a permit to 4'a 1/
I 67
a ! story, Type�M f e Buildi Use Zone�'G
VXS• a /`1 0 Occupancy /
teo be occupied only as ?771,o C ✓e/ Space Z'
'n accordance with Plans, Specifications and P % n filh rewrt� prmkler
TsTowner
imated Value of Improvements, $ � e-O
semption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
❑ statement filed ❑
undersigned attests that his State of California Contractor's License
in full force and effect end properly a/uft arises this applic on.
San Jose City Business License # _/ /Z•�
I certify that in tha performance of the work for which this permit i's issued I shall not employ any parson
any ner so�s }o violate the workman's compensation laws of Califo nia. p
wn ry��ll Address I cb 7 —5Tz`-4M6 S`J
Address221q* At1cGr NAys-.Atea
1074 Stelling Vandra
99/8-W01-i-o82
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