11280 Y011 k2iilm"O' �C' t
Tract No. Lot No.
CITYOFF SAN JOSE BUILDING DEPARTMENT
(6-15-;-7yP.C.Date APPLICATION FOR BUILDING PERMIT y U
Date (a-1C�, 19Permit No.
Application is hereby made for a pe mif t to J'ch-eln 1
a I story,Type ul Use anc
at _(Q/�� Ih�P,N� Occupancy
to be occupied only as Sc T: Sq.feet .2&Q
in accordance with Plans,Specifications and!Wan twlan fide i ar ng Space
Estimated Value of Improvements,$ Sprinkler
Emer.Elect.
1 certify that in the performan a of the work for which this permit is issued 1 shall not employ any person
Owner Ajin I Add ren
By Address :2 T 4 r�4
This permit shall 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 1�
FINAL INSPECTION \. .`11 � y G `� `\
\ 28080n{
Rev. 18/78
Exemption from requirement for State of Callfomia for Contractor's.
License is hereby claimed by applicant:
as owner statement filed❑
Applicant attests that his State of California Contractor's License No.
Is in full force and effect and properly author) th's application.
San)ose City Business License No. �
•. 21 L� � Y:
1.LOCATION I,O I Mb 2. Dg D. 3.T E RCD.
27 iso
4.READY AM-1 ) ANYTIME ( 1 5.TYPE OF 1.6.AREA17. INSPT.MADE
PM'1 1 SPECIFY , NS EC TIME
DATE
8.APPROVED 9.REMARKS:
DISAPPROVED
• INSPECTORJL' It
280-671
PINK-OFFICE
WHITE-FILE YELLOW INSPECTOR -
1..LOCATION ; 2 -DATE RCDy -,3 TIVE RCD.
4,READY AM ( I ANYTIME ( 1 5.-TYPE OF 6.AREA 7.,INSPT.MADE
PM!( 1 :'SPECIFY INSP CT.� TIME
t .DATE .� .
8.APPROVED ( . . 1 , .9.REMARKS:..' : O _I,�q C(,
DISAPPROVED -1` n 1, - J _
,�. c. - 'INSPECTOR'
1 280 671
WHITE-FILE• YELLOW-,INSPECTOR PINK-OFFICE - , ,
• 1.LOCATION ^ 2. DATE RCD. 3.TIME RCD.
.4,READY AM ( 1 ANYTIME 1 1 5.TYPE OF 6. EA 7. INSPT.MADE
PM- 1 I CIFY INSPECT. TIME
DATE;; �
® 8.APPROVED -11• 9.REMARKS:
DISAPPROVED ( 1
1
INSPECTOR
280.671
WHITE-FILE YELLOW-,INSPECTOR PINK-OFFICE