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1117 Yorkshire
Tract No.�3 I � Lot No. A f 0c)
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT _
Date , 19_7 F s .. Permit No. 4 0 D
Application is hereby made for a permit to .''���J��PyGi
astory, Type Buil'din'g Use Zone
at T/�% YouK C-16/P� Occupancy
to be occupied only as 17 Parking Space
in accordance with Plans, Specifications and Plot—plan filed herewith Fire Sprinkler
Estimated Value of Improvements, $ z I
//�/
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑ /�' _ / G •J y(� /
Undersigned attests that his State of California Contractor's License # /J
is in full force and effect and properly yq'uthorizes 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 violet thh _workmen's cc mppensation laws of California.
Owner—��> J—'L�= Address ��
By�l?o / ✓ t _ �- L6 Address
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