53549 7985 Folkstone 2�A
Tract No. 3 14 G Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date .5-- .2-3 , 196 ? Permit No.
Application is hereb� ade for a permit to Gm✓Y TQ✓G'r
�1
o_/—story, Type _/ Use
at Occuanc
�� P y
�
to be occupied only a • /PL�v. Parking Space 2
�i �/��r "re Sprinkler
in accordance with Plans, Specifi io send Plot an fi e e witth.e
Estimated Value of Improvements, $ yj OV1>
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 # �• 7
is in full force and effect and properlyauthorizesapplication.
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
in any man er so as to vio to the workmen's c mpensafion laws of Californ'a.
Ow r r Address N
gy K-jP Address °"'x
RECORD OF INSPECTION
Foundaf ion S�3i1L744+4 tib.
Stucco Finish 7 2 w8
Form 280 1—10M—5/66 ,