51757 1113 Stafford 30 .
Traci No. 3121 Lot No. OFU
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FQIj, BUILDING PERMIT
Date_�d'J� 19 GG GG Permit No.
Application is hereby made for a permit to C6#w r?Wye-T
a__story, Type'—�_ �s uild�4-`V Use Zone r?— I
at "If .fT/01=Rill 1�AkV�t S� //�� Occupancy
to be occupied only v/'°'"'� Pjcking Space 'Y
in accordance with Plans, Specifications and Plot-plan filed herewith. Fire Sprinkler
Estimated Value of Improvements, $ Rc� Vog. eea
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑ <�- Q
Undersigned attests that his State of California Contractor's License #13-1
-/ l 7p 3 46l
is in full force and effect and properly autBori:es }his`appplication.
San Jose City Business License #' 9 )dr;r
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any man aw ass�to viola}, the workmen's compensation laws of-California.
Owner �ir /7(/N�YrI/f-q—•S7lCa�—.�ACAddress tz��` •�/yW� s�1N f ft.
�i e..--z�Z- Addressr*fWL IS
l
99/5-W01-108Z -,Oj
9fluld an}5
owey��pZ'Z I uoi}epunod
NOILOUSN1 d0 amoo 1