31276 (2) 874 Csii�srd KiYi
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
72 _119—.5-7? P re �i p,_.L...?-. -Q.?.......(0...............
Date-------- ....................
A i atior
ppli ation is hereby made for a Permit to..--. --- --- ............
............/-----story, Type-.-. ...................... ------------_---------Building
at_........--"....-------------- ....... . ... .. ... -------------------------------------------
to be occupied only as....... ---- - -
----- -- ........ iE. .............................
in accordance with Plans, Specifications of-pla i he W
Estimated Value of improvements, $__ _ - _41-". .
. it is hereby agreed that the requirements oYThe 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 com-
plied 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 rp7ner so as to bac me si�kiecf to the workman's compensation laws of California'
0, WOE VAddres'-
t 114 0 /000,�
ner�� --- .. .... ....... .
By... .........Address----------__---------------------------------------------------
Contractor. Agent
r-orm 280.1 874 Grimm Loma Verde Gonst.
RECORD OF INSPECTION
Foundation-----
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Stucco.......-----.............-
...... -----------------------Finish-----
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