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Tract No. 1,214 Lot No. .2s-
CITY
sCITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date /0%?-3 , 19 671 Permit No.
Application is hereby made fora permit to u
a I _story, Typer Use Zone iq /8 6
at 1619 AS}e o1vN //' Occupancy 1'
to be occupied only as R Parking Space Z
in accordance with Plans, Specifications t-plan rinkler
Estimated Value of Improvements, $ .
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 # R-/ /J39�a
is in full force and effect and properly authorizes this application.
San Jose City Business License #4 ' W
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any manner slot as to violate the workmen's compensation laws of California.
OW F_�.Z1. YIU 4r .v- +Assoc. Address 1175 S. I-IWN 9
Address
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99/5-W01-I-08Z .,.4
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