94886 1129 ROLLINGDELL COURT ML dKPV49
Tract No. 576`5 Lot No._r
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT TL
Date_7 � , 19_7 4 Permit NofA
qApplication is here�me a fore a it o
a_6.—story,, Type.- Use Zone
at _ d[L" IzLG�� — Occupancy
to be occupied only asi Space /
in accordance with Plans, Specifications and an Z e Orth. er
Emef. Hec#.
Estimated Value of Improvements, fS4�0-oo0
I certify that in the performance of the work for which this permit is issued I sh not employ any person
in any a},fo violate th scrkmen's compensation laws of California.
ia. �� ��
Own Addressl_7 7 4 ' c"0
ByAddress c5 . CQ 9'4-1a
RECORD OF INSPECTIO 45. 1,92 *2/
Foundation 9 hL Frame
Stucco-�'' — Finish �a
260-601N
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 # X77,,4
is in full force and effect and properly authorizes this application.
San Jose City Business License # � �� / — Oo 7 c�+
9
280-601 N