53241 1135 Hollyhead 9
Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT �" ' )�)
Date c1'— 3 , 19 6 7 Permit ,No. rJS, 3 Z y /
> 1,
Application is hereby made for a permit to /pi .A�(l -
ley
a / story, Type B 'din Use Zone
at Occupancy. T
to be occupied only as Parking Space Z—
in �� dire Sprinkler
_
in accordance with Plans, Specv ification lot-pldfN C
Estimated Value of Improvements, -� �'�
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 #
is in full force and effecf and properly authorizes this application..
San Jose City Business License #-
I
I certify that in the performance of the work for which this permii is issued I shall not employ any person
in any manner so/as,fo//vvi/iolafb the workmen's compensation laws of California.
Owner In/— w.cY Address
By �_� Address :2V.':? 14- 46'
1135 Hollyhead 9 W. Wilber
RECORD OF INSPECTION
Foundation 5 , ti 7 wyl� Frame
Stucco Finish
Form 180-I—IOM—5/66