81611 1041 November Drive
Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FR BUILDING PERMIThlC�'
Date `s r7 19 P mi# No.
Application is hereb made for apermi+ +o
a story, Type I Bufld ng Use Zone
at ',Occuppncy
�J ) Pr.;,VAS
to be occupied only as � -1 1�//l/ GL' VW �
�' Fire Sprinkler
in accordance with Plans, Specifications and Plo+-plan filed herewith.
Emer. Elect.
Estimated Value of Improvements, $
I certify that in The performance of The work'for which this permit is issued I shall not employ any person
in any men so as to viy} the wo}men's compensation laws of C lifor i .
Owne LS L/C C Address � �M��76L=�
By c Address 0
RECORD OF INSPECTION
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Foundation � F/r�a�m�pe � Ag- v`- � � A4-t�l��
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1041 November Drive. James Flick
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