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CITY OF SAN JOSE .. BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
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Date --- --Kay--6- --------- ------- ----- -- 19-----40--- Permit No. ----- 33- .2,'1 --- '---------
Application is
a --- si�njgl.e.story, 1
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to be occupied only as ..
in accordance with Plans,
dwelling
of -plan filed herewith.
Building
Estimated Value of Impr?); rKet/.$.. /.
It is hereby agreed that the requirements of th an se uild V�nin(g Ordinances and all other
laws applicable to the construction, location, end use of, buildingity of San Jose, will be
complied with.
I certify that in the performance of the work for which this permit is issued I shall not employ any per-
son in any manner so as to violafe the workmen's compensation laws of California.
Owner Wh--- - - _C4nat.xt?C 41t?..GQ... :... Address , - -- 4112 - -El -- Camino -- !ay - - -- ----- -- - - --
ddress ..._Palo Alto
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Co rector, Agent
Form 280 -1
RECORD OF INSPECTION
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