10246 F:945 Rose Blossom Dr.
Tract No. 2 y0 6 Lot No. A
CITY OF SAN JOSE
APPLICATION FOR BUILDING
Date rS ? o , 19 7f Permit No.
Application is hereby made for a perr tit to QLD.
BUILDING DEPARTMENTSS
PERMIT1O24,6 F
Use Zone
at _9 yf /{'OS E .BEDS f��� /� v vOccupancy_
to be occupied only as PR.lV , ro oL c,L-�� Sq. feet
in accordance with Plans, Specifications and Plot-plrpf)oG
Estimated Value of Improvements, $ fi 00 0 Fire prinler
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 of California.
Owner M - 1" 0 N T Address Q 't'� t /�O�i L` �Q�.O aSciOM l� IQ,
By N �/� N r O Address �_� t r iw/ H F -C Tom?
This permit shall expire and come 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.
FINAL INSPECTION I� � /��'+�-�y �—� V�J 280-601 N
111GRQd/dam x`19 a"r.,t�ca<�
r Exe�from requirement for State of California for Contractor's License is hereby claimed by applican-
as owner ❑ statement filed F-1Applicant attests that his State of California Contractor's License No. —Z 20179
is in full forceland effect and properly authorizes this application.
San Jose City Business License No.
i.
2. DATE F.GD./ _ 1 3. TIME RCD.
4. READY AM ( 1 ANYTIME ( 1 5. TYPE OF 6. EA 1 7. INSPT. MADE
PM ( 1 SPECIFY TIME �N�ECT%I DATE/A-/7-Rl1
8. APPROVED ( 1,000r) 9. REMAR �b
DISAPPROVED ( 1 v
INSPECTOR
280-671
WHITE - FILE YELLOW. INSPECTOR PINK - OFFICE
1. LOCW-5--
4.
ION 4. READY AM ( 1 ANYTIME ( // I 5. TYPE OF
PM ( I SPECIFY INSPECT.
•
B. APPROVED ( 1 9. REMARKS:
DISAPPROVED (><I
/ I TIME 3�
2.•D RCD. 3. TIME RCD.
6. AREA 7. INSPT. MADE
TIME -�--�r
DATER i- 7
•
III • INSPECTOR C -
280Z'
WHITE - FILE YELLOW - INSPECTOR PINK -OFFICE
1. LO 10
• 4, READY AM 1 ,. ' 1 ANYTIME 1 1 5. TYPE OF
PM ( 1 ,SPECIFY IN CT
• $, APPROVED
DISAPPROVED ( 1
3. TIME RCD.
6. AREA ,7. INSPT.
TIME
A _ DATE?
WHITE - FILE YELLOW - INSPECTOR PINK - OFF