51757 1133 Stafford lou
Tract No. 312 4'r Lot No. Ar
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FQR` BUILDING PERMIT F 44
Date -!I—, I & Permit No._� 7 7
Application is hereby made for a permit toy LT aA; km
a_/-story, Typc ' Building Use Zone
at .0 �R 1✓ Occupancy f
to be occupied only ase
� Parking Space 7�
in accordance with Plans, Specifications and P—lot-plan filed herewith, Fire Sprinkler
Estimated Value of Improvements, $ /9j 060• ��
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑ �_/ f 7�/
Undersigned attests that his State of California Contractor's License # — PF
C/
in full force and effect and properly
authorizes this application.
San Jose City Business License #7 �'S Ty
I certify that in the performance of the work for which this permit is issued I shall not.employ any person
in any m verso as to violate the workmen's compensation laws of California. �'
Owner V• �60'✓t�� !' yC.INCAddress/A7t X/V✓fy �N `rAidr.
Address s�IM� .4s IQI�i✓t
99/8—W01—I-08d -,0,
7 ' / n y91w j l cyan}
ewwj �7 7j — �� 2?.l-'vim �iyi Punoj
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