86240 866 TLYly Ave.
Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMEEW
�r4/PPLIC�7ATION FOR BUILDING PERMIT G
Date J— /;7 , 19 T Permit No.
Application is herebymade for a permitpermit f�C- D A A D )J
s.tory, Type 2 ES Building Use Zone
at d (2[ L / L Ay r Occupancy
to be occupied only as Fi4 M, Cl3 �X F/'� n-'`, Parking Space
in accordance with Plans, Specifications and Plot-plan filed herewith. Fire Sprinkler
-
Estimated Estimated Value of Improvements, $ .3 o () - Emer. Elect.
I certify that in the performance of the work!for which this permit is issued I shall not employ any person
in any manner so as to violate the workmen's compensation laws q?f California.
Owne k S C L Address 6 G 6 L�' CIE
By � Address
RECORD OF INSPECTION
Founds ion S' liI'? 44co Frame
Stucco Finish / �l�27 J
866 Lily Ave. Len Huseby rE
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 #QW//%//9J
is in full force and effect end properly-authorizes this application.
San Jose City Business License # ' 6f/�OsA'
�S 5 )s AOW Att. AM /V"// Aft) F(,,tG M IArQ. Aic4t)
S• /3 �s - N /1AC46
Form 280-1
• 1 LOC99TIO 2. DATE CD. 3.TIME RCD.
III • 4.READY AM (4--f--ANYTIMEE ( +) 5.TYPE OF : 6.AREA 7. IN T.MAD�
PM ( ') SPECIFY INSPEC . TIME 2-
1 DATE _6_,
• 8. PPROVED ( 9:REMARI<,S:
DISAPPROVED ( 1
jv
INSPECTOR
/ 28 -671
WHITE-FILE YELLOW-INSPECTOR '. PINK'-OFFICE - \�