63065 F 1141 Derbyshire Dr.
Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATIONFA�t BUILDING PERMIT 6 S
Date—/& 19 Permit No. 6
Application is hereby made for a permit to d
a_ s+or Building Use Zone
at1/ � y/�f Occupancy
to be occupied only as r. Parking Space
in accordance with Plans, $pecificat ons an Plot-plan filed herewith. Fire Sprinkler
�Estimated Value of Improvements, $_ /LV
I certify that in the performance of the work for which this permit is issued I ell not employ any person
in any manner so as to violafe the workmen's compensation lawsofCalifornia.
Owner__T— 7 G'GR zj( •_ Address —
By Address
Xn RECORD OF INSPECTION SF�/Y C�`ljzto r
Foundation_ Frame
Stucco Finish
1141 Derbyshire Or Connor
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N 19
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