52984 (2) 1135 Elmsford
Tract No. t 2 G Lot No. TV
CITY OF SAN JOSE BUILDING DEPARTMENT
t� APPLICATION FOR BUILDING PERMIT / n
Date 1 1 7 147 Permit No. ®L
Application is herebj_made for a permit to /30 110 �/
a story, Type 41- Buildin�gy/�f) Use ZoneAJAL
of / VA/t F )Q /"/��/ Occupancy
to be occupied only as A Parking Space 'Z
,�' Fire Sprinkler
in accordance with Plans, Specifications an' P f-pl/ i
Estimated Value of Improvements, $_�� 000
Exemption from requirement for State of California for Contractor's License is hereby claimed Iny undersigned:
as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License # T 7 I
is in full force and effect and properly authorizes thhiis application.
San Jose City Business License # A Os—qa
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 'olelq the workme 's compensation,laws of N ���Qt
Owner .•FFOO J T �R• Address/-/? N G.
By �1�. rIP! Address�LNw�
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99/5-W01-1 005 w,°j
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