53821 1043 Colony Hill
Tract No. �53 Lot No. gcl
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT``'']j
Dates )l)A)k /6 . 19 97 Permit No.�
Application is her y m d o , p '4 to
�Q a storY, Type �6 e< 2$a Use on :peYP
ai L 141—<, Occupancy,
to be occupied only as-LAf JQ Jc Parking Space 2
in accordance with Plans, Specifications a lot-plan h rl¢v� F Sprinkler
—
Estimated Value of Improvements, $ Q �v
Exemption,f./rom requirement for State of California for Contractor's License is h reby cle imed by undersigned:
as owner statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes 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
m any manner soas to viola# he kme s compensation laws of California. G� �n
Owner �tl ivr��/jAddress�� ° "r' vC
By r Address ///
1043 Colony Hills Barbara Dodsworth ( � P
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99/5—W01—I o8z w,oj
8961 r z
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