53754 1138 Stafford //
Tract No. 1.14 Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
r APPLICATION FQR BUILDING PERMIT
Date✓ S —. 1 J Permit No. 5-3 zzl ��
Application is hereby made for a permit to
a a story, Type Building Use Zone v
at 1/38 f'o00r4> 14v, a ,p G Occupancy
to be occupied only as . W4551C �" • KCS• Parking Space 2
in accordance with Plans, Specifications and
Plot-fila�led herewith. Fire Sprinkler
Estimated Value of Improvements, $�7� OV�
Exemption from requiremomf for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑ RQ ec C
Undersigned attests the+ his State of California Contractor's License #p/_
is in full force and effect and properly authorizes this
�application.
au
San Jose City Business License # `� —/u, • g
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any mannjer so as to viola+e the workmen's compensation laws of California. �•
Owner /C T�f/�TLR27 Address ��,?J�•S /��"'
By7So.r� ' gag `'� Address/1��~--4 e
WS—W01—I OR w+a1
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