53549 1162 Stafford
Tract No. J1 2-6 Lot No. G
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date 1 Z , 19 G z //1� Permit No. 5-3J--Y7
Application is hereby de for a permit to lAajwoprTr—
a story, Type BuildingUse Zoned-�
at A,02:�? Occupancy
to be occupied only a Parking Space Z
in accordance with Plans, Specifications and Plot-(plan filed h/eerreJe�w,,it��h. Fire Sprinkler
Estimated Value of Improvements, $ A2&j u�� `!V.lU�Fj�
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 # /3II r 6 I
is in full force and effect and properly
'aLuihorizes This appplication.
San Jose City Business License # T _I;-S�O
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any meiJe so as To viol to ihakworkman's co pensation laws of California. A
Own Address y
By Address eVo --✓QO
99/5—W01—1-00L w,oj
G9 S z W e� 9 uoi}epunc j
N01103dSN1 dO 080031