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CITY OF SAN JOSE BUILDING DEPARTMENT
APP (CATION FOR BUILDING PERMIT _
Date k13 D , 19-&7t] Permi+ No.
Application is hereby made for a permit to /✓N i /./
a story, Type 'eS, din //� Use Zone
at O Occupancy
to be occupied on 4 Yt�/. Parking Space
in accordance with Plan Specifications and Plot-plan filed herewith. Fire Sprinkler
Estimated Value ofr ve $ _ya5�%a
Exemption from req u,re a S4 fe of r7 i�rn o act Li nse is hereby claimed by undersigned:
as owner ❑ statement f,ad ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes this application.
San Jose City Business License # y /6 Jl u611
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 14 Address SA& N S. `T
Address
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99/5-W01-I-OBL w,°i
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V N01103dSN1 dO OVOOM .