51757 (2) 1139 Stafford
Tract No,3( 2. ® Lot No.-1-3--
CITY
o._1 3CITY OF SAN JOSE BUILDING DEPARTMENT
/�
APPLICATION FOR' BUILDING PERMIT _ 4 1
Date'0 'i X/ — 5 199 L Permit No. - (/7 5 7
"Application is hereb made)for a permit to _01►LuIPdGT
a_/—story,JM
�� Building A/U Use Zone R,
at 131 sfIAFA1'� IVSE /�.7,� ,r Occupancy
to be occupied only as -5tm"r F.PM #?fWa 1//V�/P�; ' Space
in accordance with Plans,Specifications and Plot-plan filed herewith. Fire Sprinkler
Estimated Value of Improvements,.
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
1 as owner ❑ statement filed ❑ '
Undersigned attests that his State of California Contractor's License #
11,111141 13-/
is in full force and effect and properly A —au�thorizes/thiss application. . ,
San Jose,6y Business License #`. T 1�J 7 B r
I certify that in the performance'of the work for which this permit is issued I shall not employ any person
in any manner soa to violate the workmen's compensation laws of California. :'
� ,r,_,/[ hYN A j� S*4:XWCAddress If)S S, 914'" oloy
Byl1Lj�pr.. t Address :f�91NE AS Nd��6
i
99/5—NoI— OBZ woj
014RDunoj
N01103dSN1 d0 G80038