52469 1148 Elmsford
Tract No.3126. Lot No.
CITY OF SAN JOSE IBUILDING'DEPARTMENT
_ APPLICATION FOR BUILDING PERMIT ��
Date r�6 , 19 (i Z Permit No. ,SZ 1%!2
Application is hereb made for a permit to (•3VILD•
a ( story, Type� / Use Zone ('a L
at I F.sfMS 1 V / Occupancy
to be occupied only as EGT Parking Space
in accordance with Plans, Specificati s 6d I p n il rewith, Fire Sprinkler
Estimated Value of Improvements, $ &%&* F`i
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑ �J S 3 / /
Undersigned attests that his State of California Contractor's License # s s 79 V
is in full force and effect and properly authorizesyt�; application.
San Jose City Business License # 4t-1 T
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 theworkmen's compensation laws of California. a
Owner Z Mr egSZCV- 109'Address /Iz' -ky ! GJ" T
By�r� .�✓__ Address r�4^0 �`^"�
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