52896 (2) 10417 Colony Hills
Tract No. Lot No.
CITY OF SAN JOSE :,BUILDING DEPARTMENT
//��,, �� �APPLICATION FOR BUILDING PERMIT
Dated 196-27 Permit No.
Application is hereby made for a permit to 49/? 7 /6
a I i#ory, Tvoe - u' 'rg 9 / Use Zone
t Opancy
a - ) ccu
to be occupied only as (A D,(� MParking Space
in accordance with Plans, Specifications and Plottlanfilecl.h rewi#h,/Fire Sprinkler
Estimated Value of Improvements, $ N ,
Exemption from requirement for State of California fo }r }or's License m heraVlai by undersigned:
as owner ❑- statement filed ❑
Undersigned attests that his State of California Contractor's License # 16 5?!? 7
is in full force and effect and properly authorizes this application.
San Jose City Business License #
I certify that in the performance of the work for which }his permit is issued I shall not employ any person
in any manner so as to violate the workmen's compensation laws of California.
Owner�ilL1L-f E / /n /D 4) Add rest r�u'�-V�-�
By Address n4q�,_4, - 11A f R�y�t S 1_� VLA
/lpg7'� o I ` 11's`f Gove Cello (9
99/5-W01-I-08Z -,.j
7 - , ylu!d — 000n}S
ewgu uoi}epunod
NO11O3ddSSN1 d0 G8003b