53754 H50 Stafford
Tract No.(/ ' Lot No�V
CITY OF SAN JOSE BUILDING DEPARTMENT
r APPLICATION F R BUILDING PERMIT
Date , I Permit No. .6 3 7—s—Y no� ✓
Application is hereby made for a permit to CeAx`✓aS77?11L7—
a story, Type 3 t Building/ Use Zone O
at //S G t'FOIPp pIQ! d WTD Occupancy
to be occupied only as S/4#6IC FA/gI. - Parking Space
in accordance with Plans, Specifications and Plot-plan filed herewith. f. e�Sprinkler
Estimated Value of Improvements, $ o2d pAV
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑ [�G
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes thiseapplication.
San Jose City Business License # 4 —1Ci
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 y�a workman's compensation laws of California.
Ow�r lT/+JA�6A� i 'SlSJoe•rwe Address //73 s• NNS S, Sia Tass
By O ( �'/� Address fdillic`"r•eQo �'�
99/5-W01-I OBZ w,ai
eh6Ot - �
')obb '� .ct
7 J 'D f Ylul 000n}S
C �
157 lg we,d C 7 ' I Z ' 7 uoi}epunod
NO11O3dSN1 d0 MOM