42056 601 September
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Tract /N/o., ..... Lot No.
Date...................../ J�� 19--- Permit Z121' -------------------
6 " 7- -- --------
Application is hereby made for a permit to --------......................
a........L.....+cry, Type.jr—_R_101� - f___ U_--------------- -..--- Building
Zone . ..
f... ...
at .2-ozr... ---------------- If
to be occupied only as ./ -�� pancy ....... -----
y �F�m---- ----------- Pa ing Space ......................
in accordance with Plans, Specifications and Plot-plan filed herewith.
Estimated Value of Improvements, $.Roo._� ....................
If 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
complied with.
I certify that in the pe rfcr.ance of the work for which this permit is issued I shall not employ any per.
son in any manner so as to violate the workmen's compensation laws of California
0'�
Owner ---- ------------Address !1. .......
coatradssr7�7 -------
ByAg.nt Address -------------------- --------------------- --------
------------------------- ---------------------------------
Form 280-1 801 September Nancy T. Stall
RECORD OF INSPECTION
Foundation . ------------------ ------------------ Fcame ---- ----------------- -------------------- ------------------ --
Stucco ------------------- .............