522521100 #91rA8(f.okd
Traci No.st:g� LoT No.
CITY OF SAN JOSE- "I BUILDING DEPARTMENT
c APPLICATION FOR BUILDING PERMIT
Date I - 19 G % Permit No. 57Z -Z -S �-•-✓
Application is hereby � -AV
for a permit to r9NIX ✓Gr '
a_2 story, Type Buildi5qJ//� Use Zone - 6
at J sS PFdL,O /A�-y/ v Occupancy
to be occupied only as ,�'/I✓t_% /�A_M� T' /1 / 9 Vice
in accordance with Plans, Specifications and Plot- rJfite ere/witch, i Spfnikler
Estimated Value of Improvements, $ 21 ours. oV
Exemption from requirement for State of California for Canfractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑ ^ ' /
Undersigned attests that his State of California Contracfor's License # ,3
13
is in full force and effect and properly authorizes thdis ap plica+ion.
San Jose City Business License # lost 48
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 •J ✓ !t�[ tI�jS0.'. �• Address �/ 7 -!x -S. ✓% Si J�ipn/ as8
By Address S4649F AS A&V ✓E
p ,p� ys.wj
NO11O3dSN1 dO 480038
99/5 — W01 — I'o8z w�Oj
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