82498F 1158 Scotland Drive qQ
Tract No.—>�Lot No.P2L�
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR_BUILDING PERMIT �
Date /_/_57 19�y j Permit
pAp lication is hereby madepermit t UILl�
a t story, Type i Use Zone
a+_/ /5-9 �.CQf .Q Occupancy_
to be occupied only as _ �� - R+a . - rf/? L1J� �•ki
in accordance with Plans, Specifications and Plot. an it he e i V ce
Pr n erg
Op Emer. act.
Estimated Value of Improvements, $
I certify that in the performance of the work for which this permit is issued I shall not employ any parson
in any manner so as to violate the workmen's comps nsetion laws of Cali(or2j{.
Owner u1aA-U-54/J Address JC��/�✓u� �n .
By_ 7pr-k �n' Address`72M 4P- h�&-Q�
RECORD OF INSPECTION
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