52653 1151 Stafford 3ouA3
Tract No.3112 (0 Lot No. f
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date L '� 19� pp Permit No. S2fo 57�
Application is hereby made for a permit to
a_Lstory, Typed . Building i Use Zone
at I� .moi rr"t F�KD, r�� n v4-</Occupancy �
to be occupied only as r'-4p& 1 dd Parking Space Z.
in accordance with Plans, Specifications and Plot-planifiled herewtthnyv P
Estimated Value of Improvements, $ -2-a 1uOJ'04'
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑ R
Undersigned attests that his State of California Contractor's License # 13- 1 - 7 /
is in full force and effect and properly authorizes }his application.
San Jose City Business License # y eta V ��
I certify }hat in the performance of the work for which this permit is issued I shall not employ any person
in any ma,nJJler so as to violate the workmen's compensation laws of California.
Owner I('t� Its avis-r t Afro .;*VC-Address
By 4• V' AddressCAW
t'
99/5-W01-I-OBL —01
9-,nV 9 i ysiuij oaon+S
y G sewejd--.�c¢o `J'/tel uoi}epuno j
NOIlOUSNI d0 MOM