62127 F (2) L149 Derbyshire
Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT ae5�
Date ��
19 No. �/Z7�
Application 1,
hereby de for p r +
a-1-sstyory, Type a• i Use Zone
at_/LY' _ .`l� occupancy—
4) n ace
to be occupied only as 9v pnnkler
in accordance wi+h Plans, Specifica ions and Plot plan filed herewith.
Estimated Value of Improvements, $_J_122
1 certify that in the performance of the work for which this permit is issued I shall not employ any person
in any manor.sof es�yo .oI to the workman's compensation laws of California.
%EOwner_/`�"j Address
Byl//� �' Address
RECORD OF INSPECTION
Foundation Frame
Stucco Finish
1149 Derbyshire Kirby Miller II
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