69205-F 0'1171 Stelling Rd.
Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APLIGATION FOR BUILDING PERMIT
Date �,1 1 19 7/ Permit No. / CJS—
Applica}ion is hereby made for a permit to L OIVJ77211)CT
a story, Type it ' Use Zone
Occupancy
to be occupied only as kly"} PT�6 ._ Parking Space
in accordance with Plans, Specifications and Plot-pla &R-here �f'otr
Estimated Value of Improvements, $ 3 Y/
I certify that in the performance of the work for which this permit is issued 1 shall not employ any person
in any me er so as fo vi e,the workmen's compensation laws of-California.
Own = / / Address ]]]/ �Of1(�.
Address 9/6 ; 1W 771a J)
FOE L/FE7 AqE ( �ECORD OF INSPECTION P• fl.
Foundation ���—� y Frame
Stucco / /Finish
1171 Stelling Rd. Berk Simonds �jC
Exemption from requirement for State of California for Contractor's License is hereby claimed by applicant:
as owner
❑ 'statement filed ❑ -7 p
Applicant attests that his State of California Contractor's License # 22Q SO 2—
is in full force and effect and properly authorizes this application.
San Jose City Business License #
NOT /No-m,' Do4IN00�1) Lr-vg
Form 280.1 5/70 IOM