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1 -CIT-Y—OF-SANYJOSE•--;—,--.--'------,--BUILDING-DEPARTMENT
LOT_./_L-z _APPLICATION FOR BUILDING PERMIT
Date------ DEC_2....... c7
.................. 19....... Permit No...21r2 ................
Application is hereby made for a permit to----------- .................................................
a-'-'-- -----story, Type--------------------- -----------*------------------------------------------*....Building
VAC
at......................... ----------------I .1---J..........X__........ :..............
_;-.................................. --------
to be occupied only as..... ...................
.................................-Y-----------------------------------------
in accordance with Plans, Specifications a;d Plot-plan filed herewith.
Estimated Value of Improvements. 411le
................ ...... ::,1
It is hereby agreed that the requirements of the San Jose Building and Zoning Ordinairc—esa7idell—oft-or
laws applicable to the construction, location, and use of buildings within the City of San Jose, will be com-
plied with.
certify that in the performance of the work for which this permit is issued I shall not employ any per-
son in any manner so as to become subject to the workmen's compensation laws of California.
Owner. .........------- ..............2...........-----...Address.---.....` -...... ......i-
BY-------------- ................................Address.......... ....... ---------
ev,
Contractor 4genf-
Form 2804
RECORD OF INSPECTION
Foundafion._
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