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Tract No. 4,21°1 Lot No. 3
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date /0/23 19617 Permit No. E z S3.4✓0'
Application is hereby made for a permit to RC4, jd
a I story, T . Bu' ing Use Zone
0. S
iB6
at 7�a0�
� /(/ O Occupancy
to be occupied only as _� a x Parking Space Z
in accordance with Plans, ecifications and Plot-plan fil erewith. Fire Sprinkler
Estimated Value of I � $
Exemption from require S a of Celif i' f r nt cf s Li a by claimed by undersigned:
as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full force and affect and properly authorizes this application.
San Jose City Business License # 4k — e
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 4 N�r�e d SSoc. - c. Address 1175 5• I�w _9
By Address
99/5-W01-1-08Z -,Oj
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