53408 1091 Milky Way
Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT�''
Date /1-1 -'09y 1G , 1910 7 Permit No.OL��$
Application is hereby made for a permit to C;1-19
a-4—story, Type 41 Use Zone
at//79/ /J/I/L&,Vkl/'1)/ Occupancy_
to be occupied only az�/JATYO '06z�W�,� F pace Zwl
in accordance with Plans, Specifications and Plot-plan filed herewith. Fire Sprinkler
_o jso�-CE
Estimated Value of Improvements, $ y�
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes this application.
San Jose City Business License #
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 violaie the workman's compensation laws of California. ,,,
Owner^:C—c�������ZrP`� Address_/V�� �/��'/X-4I"�
By Address
1091 Milky "Way C6McMahon ~—
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