53754 (2) 1144 Stafford 3��
Tract No. k Lot No. 7
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date ��'� , 19 02 Permit
Application is hereby made.for a permit to A r 0QrGT
a / story, Type `� �Buildrn9V Use Zone-��
at // Pr'a-vv AV. Occupancy
to be occupied only assJiWe-ler�� � Parking Space —
in accordance with Plans, Specifications and Plot-plan filedlehere
�Fir'e Sprinkler
Estimated Value of Improvements, $Z&jlR0O
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License #�{S
is in full force and effect and properly authorizes this application.
San Jose City Business License # `f— / ok
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 violate the workman's compensation laws of California. C _
Owner t/�•T ¢4g;� ' Ar -9• Address�/7 J X. Nky y 7' "'S• J
By�.�_eA �6 ✓'/� Address J�03'9 G�'
99/5—W01—I On —03
yflUlj Goon{S
Did ?7/7v ` 9 i Z , 9 uo14epuno j
(/ N01103dSN1 10 G80038