32986 (2) CIT �F SAN�6ik"" BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT I
Date---�r
......... .. 19 Permit
, .. .........
, .................. ........- - --
Application is I ere m de for a ormi+ to ------- ......... .....
-.story, T -- - - - ------ -- -- ----- .... Building
to be occupied only)N
in accordance wif P �=C_i_fic
�d?
Estimated Value;�_,�P.A 06
of 14 D/0- -----------------
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
complied 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 violate The workmen's compensation,
ompensation laws of
/? _/_ California..4
Ovvner.7,�,)j4vn�,_ .....Address �.112K,4�........A44'
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BYW---------------- .......
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Znhra`� --- -.f
Form 280-1 - I ----------------Address(
to'.
RECORD OF INSPECTION
FoundationI_ !f? `-V----
Sfuko ------------`----- ------------------------------------ Finish J �-��'.....'-9 4 14fc --------------
P ,3703 '
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