51757 (2) 1125 Stafford 3`°
Tract No.3/2 G Lot No./;
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT F-k-
Date 19 ale. Permit No. J y 75-
Application is hereby made forr1a permit to coN:rwwor
Appli
a_/ story, Type JLC ( Buildmg7700` / Use Zone
at Jit S, JTiIFF��? x .ST A Occupancy_
to be occupied only as owe � � $p
Parking� ace�'7�
in accordance with Plans, Specifications and Plot plan filed herewith. Fire Sprinkler
Estimated Value of Improvements, $ ONO, w
Exemption from requirement for State of California for Contractor's License is hereby claimed by,undersigned:
as owner ❑ statement filed ❑ !�,
Undersigned attests that his State of California Contractor's License #13-1
is in full force and effect and properly 1puihorixes this application.
San Jose City Business License #�4. 1 Q S
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any ma er so s to viola}e the orkmen's compensation laws of Calif or ia.
Oyyn r!�/ r Ate r ddress �7 W �/ fIVAO J6jr
Address �Mr A f}QO✓t
99/5—W01—I-O8Z w,oj
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