54298,4o'7'Y73 Stafford
Tract No. 3126 Lot No. 2 yG
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date July 20 , 19 67' Perfnit No.
Application is hereby made for a permit to l�
a two story, Type residence B ilding, Use Zoneq
at 1173 Stafford Drive,Sen sese';0Gal�if.Jj�� Occupancy_
to be occupied only as one familyel Parking Space Z
in accordance with Plans, Specifications and'Plot-pl" a>�edhre it Fire Sprinkler
Estimated Value of Improvements, $ 24,000.00
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ff statement filed ❑
Undersigned attests that his State of California Contractor's License # B1-193961
is in full force and effect and properly authorizes this application.
San Jose City Business License #4-10548
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 R.J u ter & As sates Inc.Address 1175 S.Hwy 9,San Jose,Calif.
B Address same
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