52707F 921 Sage Ct . .
Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
�j� APPLICATION FOR BUILDING PERMIT
Date://a-,(,-�, k— , 19 6 7 Permit No. 5 2 u
Application is hereby made for a permit to —• D94 p /
a story, Typ pa-r BuildingUse Zone
ati Occupancy_
to be occupied only az R41. /(/(�'arking Space
in accordance with Plans,'Specifications a d Plof-plan filed herewi+h, Fire Sprinkler
Estimated Value of Improvements, $-73—r O-e4
Exemption from requiremonf for State of California for Contr or's icon a s e cl by undersigned;
as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes this application,./
San Jose City Business License #_ �� Y o
I certify that in the performgnee of the work for which this permit is issued I shall not employ any person
in any manner so as to � afe Vh_0 workman's compensation laws of California
Address 9Z/
By f .lt�+� Address .4" 572 - 7 4r� f214
921 Sage Ct. J. Verducci
99/5—W01—I'OB¢ w�oj
9c)a s j C�
—ysiw j 000n}S
ewoid c�. uw}apunod
N01103dSNI d0 (110031