71767 7592 Hollanderry Y1. Nsr2 ° J-/
Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENTp
APPLICATION FOR BUILDING PERMITy �4
Date �' 1922 Per it No. //
Application is hereby made for a permit to Q��� lc,
e
story, Type u gl/C/ Use Zone;T
at _ 2 0Occupancy /
to be occupied only as IC %—A rvL (2h/.f Pft i,u�, Parking Space
Fire Sprinkler
in accordance with Plans, Specifi n t '�°eri Emer. Elect.
Estimated Value of Improvements, $ UG G
I certify that in the performance of the work for which this permit is issued I shell not employ any parson
in any me er so as to violate the workman's compensation laws of California.
Ownery� ��` Address
By Address
RECORD OF INSPECTION
Foundation/
Stucco Finish s/ri�7� �1JLClinq'I,P/1 /
7592 Hollanderry P1. g Re D. Hiadon Jltc
Exemption from requirement for State of California for Contractor's License is hereby claimed by applicant:
as owner ❑ statement filed ❑
Applicant 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 #
Form ?Rn.t Inn inns
1.LOCATION 2. DATE RCD. 3.TIME RCD.
`"�s�1 D GGE,✓
4.READY AM ( 1 ANYTIME( 1 1 5.TYPE OF 6.AREA 1 7. INSPT.MADE
PM ( 1 SPECIFY SPECT. 9 TIME
DATE
B.APPROVED VK4 9.REMARK/
DISAPPROVED (
Acv /
i�
IVOR
r 280-671
Fl WHITE- FILE YELLOW-INSPECT R PINK-OFFICE