03124`APPLICANT: BEAR DOWN, CARBON COPY MUST BE LEGIBLE.
DO NOT WRITE IN SHADED AREAS.
CHECK HERE IP YOU NEED A CO P. c, Ea
OF THIS APPLICATION IN ADDITION
TO YOUR PERMIT AND RECEIPT ❑ EP• T • I= tel)
PERMIT REO'D UNDER FLOOD CON.
TROL DIST, ORD. S9.1 PERMITP I J
TN IB BPAe
❑Y(S ❑NO JAN -27-65 z 7:115
0
In confamlry with the yrorl0ons of Sec" n 7031 S o1 Ilw &nibs and Prolurons
Code and Sealan 9800 0l rha Lobar Code al the State of California, a pllmnt shall BLDo. INeP.
1011 with the Build Inspector IN certlR
oals>tr��lt�>f>®
shall Indteale ltrm f, 14 carol, dt Snored M III and 12) below and/or �)
I. IS! or (6) rrhkfr7er is oPPlkobie.
X11 CartHlCole of Consent of Self.lnwr11d Issued by aha Director of lirdunrlol R.loliem. �
2 Cerlillcula (or exact duplicaa copy) of Workman's Compeneall n &?"IOIrae booed
Azel 14-5 �- CA -t-
Q on adTheled fnwtar,
13I The mat of the urork t ba t
o Per orated Is *100 or less.
Q 14J 1 cenify that In Iha pedonnance of Ify war► for whfth thh
Ihot 1 shell not employ a Permit is Issued
on
HEALTH DEFT.
to the Workerri s 41.n tie roamer so Or 10 becorw sublets
QL'iampenI lows of Collfarn(O.
(51 I only Ilwr
,
Is li
at onplan 0 Ikemed under the PrOviriens of Chopyr 9
LomrnenclnQ at Secllan ip�pp� of dfvlslen of the &nines and
rohislons Coda• Ord mrd aPPtimnl's Callfornlo Stage Contractor's License
LOC TION
-No.
RHO. 8 v 1 as
!0151ACO110n Is In full large Ond effect.
O (6) AppUCont h exempt from ISI above gender the Oppllcable pProvlslam of
Section 7040 through 7057 OI the CONTOQarl' llceme low. MCI• basis for
axempllon.)
Q�
/
APPLICANT'fl
SIONATURE/J - -
PLANNING CIE",AO
��I
DRESS
COMPENSATION CENTIPIC:ATE WWI !�•' "
THIS APPLICATION 15 A BUILDING PERMIT WHEN PROPERLY
FIRE MARONAL
FILLED OUT,
SIGNED, AND MACHINE VALIDATED IN THE SPACE PROVIDED.
PERMISSION IS THEREFORE GRANTED TO DO THE WORK INDICATED
BELQW IN ACCORDANCE WITH ALL APPLICABLE ORDINANCES, LAWS
AND REGULATIONS.
OTHER
1 • • e
NEAREST CROi9 STREET i•,
�(iL'' APPIICANI" A EAS T WR4ED N S DEDBLIA
_
OND OEAMB CC MC. BLE)
PRINT OR TYPE • 1HE 2nd CbPY IS YOURS
1• FOUNDATION FOwyB
APPLICATION FOR BUILDING PERMIT
E• FORMS
COUNTY OF SANTA CLARA
BUILDING INSPECTION DIVISION
POUR NO COI
)tGE r'"Jo tf4
20 WEST NIDDINO ST. •
SAN JOSE, CALIF. 9J110
TELEPHONE 299.2351
2. HCATINO . DUCTS
LOC TION
e. COMFORT COOLI No
LOT BLOCK
TRACT
B. GIRDERS
STREET e; ADDRESS
DO NOT COVER PLOORS UNTIL THE
1�•
NEAREST CROi9 STREET i•,
/
_
OND OEAMB CC MC. BLE)
OR
O7
►aQT
❑ EXCAVATE TTPE OF
❑ 1111110 0REMODEL C) ADD TO '•�
SO. FT. NO. OF
112E Cr— STOR I EO
OTHICR STRUCTURE
NO. I SEPTIC
IOQ7 ED
MPROV Rhl:w 8 ORADE a DELL
EFAIA [3 OVE CONyERT OICALIIN
/ NO. OF
FAMILIES
e. SEWER INSPECT.
P. 0 PRESSURE
a _ r o ,
l0 A 4 UES AMR 8
DO NOT WIRR UNTIL THE Al
11. DOUGH ELECTRIC WIRING
/
COXER NO WALLS UNTIL THE
12. STUCCO W IRE • LATH
13. PLUMB 1 NO FINALE IPrx TuaR•1
IiI. GAS APPLIANCES
1S. ELECTRICALPINALIreRTVAEa1 r
14. PLAN. DEPT. A.e.A, rH•P [GTrON
17. ENCROACNMEHT . L.O.
FIDE MARSHAL y
0. CLEARANCE RSOUIREG
19. BUILDING COMPLETc
1OVE HAS BEEN SIGNUO
HAS SEIiN STONED
16 HAS 13EEN SIGNED
NO UTILITIES WILL 8E CLUAREO UNTIL. "BUILDINO
OIB A
O b
HEALTH OEPf.
12 1. SEPTIC T.U. N.
I
HAS BEl?N SIGNED