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CITY OF SAN JOSE J BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date.....--.. ------ ............195 Permit No..3....C..;4_6A....
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Application is hereby made for a per it f �5�
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......Building
....0ory, Type.,_�.�. � . ......-=----------
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to be occupied only as-------------1_� .......
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in accordance with Plans, Specifications and Plot-plan filed herewith.
Estimated Value of Improvements, $13, .
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 com-
plied with.
, certify that in the performance of the work for which this permit is issued I shall hall not employ any per-
son in any manner so as to become subject to the workmen' o onsation laws of California.
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.....................A dre,:..Y la�c4e
Owner. OW4A �h
..........Address.........-------M-LP-.....------------- 0..
By..........�i -- -----7;"
Contractor, Agent
Form 280.1
RECORD OF INSPECTION
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