66907 7628 Westhill Lane
Tract No. 3 F S o Lot No. y
,CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date /o — / �— 19 "�' G Permit No. to /
Application is hereby m e for a permit to do
a_story, Type ne Use Zone
a+,;;7s y hJlZS T ✓�✓ -L Li/f✓(z' "tpi> Occupancy k
�/p3N .C`'1�X��l /�r Space 7.�—.
to be occupied only as �Fi�. Sprinkler
in accordance with Plans, Specifications and-Plot-plan filed��arifh. Emer. Elect.
Estimated Value of Improvements,
I certify # in }he perfor nc }he.work fppr which this par it is issued I hall no# a ploy ny person
' in eny m er so es # vio a e. oikm6 �fompensetion laws of� ffornY.
OwneAddress �/ � r
By Address
RECORD OF INSPECTION
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