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Tract No. .s Lot No. a�o
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT /
Date /o�a3 19 (0 7 Permit No. S"S'�- S'3.0/✓
Application is hereby made for a permit to e u . f-
a _story, Type 3 Re s Building Use Zone
at 63 Ste-, Lwv` ¢ � Occupancy
to be occupied only Parking Space Z
in accordance with Plans, Spa ications and Plot-plan filed herewith. Fire Sprinkler
Estimated Value of Improvements, $ 7 fa^C
Exemption from requirement for State of Cali ornia ontraetor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑
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 # 4 - /o-S-1/F
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 violato the workmen's compensation laws of California.
Owne 1. µ"'^kir 4- Assoc. c Address 1175 S. Nwti. 9
B,� Address
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