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CITY OF SAN JOSE BUILDING/DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date__ �7_�_, 19 6 2 Permit No. 5-g5Z12-
Application is hereby made for a permit to /?U/�e , 40
a 'I- story, Type ^ � d 1_*X Use Zone
at z?/ Occupancy
rn a. ��o f�RNJ Occupancy
to be occupied only as /- CAK/L y 3 �� Ll t :�pPaarking Space
in accordance with Plans, Specifications and Plot-plan filed herewith. r%re Sprinkler
Estimated Value of Improvements, $ 22-1/� O D a' .
Exemption from requirement for State of California For Contractor's License is hereby claimed by undersigned:
as owner 21� statement filed ❑ p
Undersigned attests that his State of California Contractor's License # A3 3 7 G
is in full force and effect and properly,/authorizes this application.
San Jose City Business License # Y` /0'5 U�
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any manner so as to violate the workmen's compensation laws of California.
Owner V CZ i Ve.Address So 1-1i114 /' 7r' 15.T•
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