5167 7592 Hollandery Pl.
Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date ' 19
Permit No.
pplicatio i hereb d for a permit[o V 5
a story,T 8 Iil ' g• se Z ne
at
y Occupancy
/
to b occup ed only as r>^ Sq.feet
in accordance with Plans,Specificatio s ,Flot•p fiJeP eSC it — wing Space
Estimated Value of Improvements, $� .j°J! V C/ Ire Springyler
Emer. Elect.
I c rtify that in the performance of the work for which this permit is issued I shall not employ any person
in any a r so as to ate he workmen's compensation laws of California.
Owner
Address
6y Address
This permit s\ expire and become null and void if the work authorized by it is not commenced within
120 days from the date issued or if the work is suspended or abandoned for a period of 120 days after
commencement. q �
FINAL INSPECTION 241 q2 - — 260-601 N
Exemptio 4rom requirement for Stateof California for Contractor's License is hereby claimed byapplicant:
as owner [!7 statement filed ❑
Applicant attests that his State of California Contractors License No.
is in full force and effect and properly authorizes this application.
San Jose City Business License No.
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