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CITY OF SAN JOSE tor....:..1.�..........WISTLYN TRACT 2167 BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
SEP 23 1°S 3 SS
Date...... ...,..- -- " 195........ Permi# No. .....---- - -..... -
COnBf,Ti1C'E
Application is hereby made for a permitto...._._.._......__................._-_..........--_........_.-..
Y res _.Buildin
a.--------1--------story, Type------_...-'------ --- -....................------------------------------------ g,
at be. .. ...-5? _ . _ ...
occupied only as...........I----- .-1RS...-.`'------..-.------.residence
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in accordance with Plans, Spocifica#ionss ( lot-pla 11 4v�
Estimated Value of Improvements, $._(�:`
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.
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 become subject to the workmen's compensation laws of California.
CLAUDE-T..�L`yIN11SAY, INC.Owner.------- ._--- .-. ---- ---------------
---
- ._.- Address...................r .EhEaminofeal------
ddress.................Menlo park, California
By-- / ontraDA3-4ll8
ctor, Agent
Form 780.1
RECORD OF INSPECTION
Foundation f & — /J� �:L_'..� --✓� �op.,M4............
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