28609 CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Tract No.,Z� K-2 Lo't No. 2�_
Date...................... -—----------------- 19_1C2�— Permit No.._11(0.01........
Application is he!eb"dia er i �o ....... .......... ................... --------------
a---P.04�....sfo ry. Type-- ------- .... ).q.a ............. -------------. Building
... .. . ... .... ....
at Use Zone
Occupancy --------
to be occupied only as .TW_ ... Space .......Z-----------
in accordance with Plans, Spe Viflot s j 1p,f 'Vantterewith.
Estimated Value of Improvements, $---f --/..............
It is hereby agreed that the requirements of the San Jose Building and Zoning Ordinances and all other
laws applicable to the construction, location, and use of buildings within the City of San Jose, will be
complied with.
I certify that in the perfcrmance of the work for which this permit is issued I shall not employ any per-
son in any manner so as to violate the workmen's compensation laws of Califcmia.
Owner
A
ddress ---- ---
Contractor V ABYAg.nf --- - -------- Acdress
Form 280.1
�j /RECORD OF INSPECTION
�Fo:u�n7darffiA.f !. `�' `�P :1I 7.-- Finish
UCi. c--cco --..-... .... v- �_'
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