14871165 Rollingdell Court
Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT �=
Date S , 19 77 Permit No. e)/� �7
Application is hereby m for a permit to 75 -'ib Pont
a story, Tyype 'Idi Use Zone
at Occupancy
to be occupied only as r.✓ ' F- kc, ParkingSpace
in accordance with Plans, Specifications en P nofil
r r
m r. Elect.
Estimated Value of Improvements,
I certify that in the performance of the work for which this permit is issued I shall not employ an✓person
in any manner so at to violate the workmen's compensation laws of California.
gy �Address
/Owner d ��SF,oZ
Address H46'l �///z e_
RECORD OF INSPECTION
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