67154 (2) 11480 Gardenside
Tracf No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date J/� a ig 7- Permit No. v /`� f
Application is hereby made for a Perml
Yl
�S
—
a_�story, Type E N ✓ in Use Zone ��
at////� R _ —Occupancy. .1__
to be occupied only as_I r✓ Parking Space
��A�N`/J� irE'Sprinkler
in accordance with Plans, Specificatio of• a CC rjj ,7nj�/,��
Estimated Value of Improyements, $ �.SOt�.0-y
I certify that in tho performance of the work for which this permit is issued I shall not employ any person
inany manner so as to violate the workmen's compensation laws of California.
0wner_q C' �-< f{" fSo @ . Address /777 Sp/1R To 6A AfE
By '�� rr•� Address /9�� SNQ47omA qUf
RECORD OF INSPECTION
Foundation l_�_
Stucco Finish (V
11480 Gardenside R.C . Moore / "t
Exemption from requirement for State of California for Contractor's License is hereby claimed by applicant:
as owner X statement filed ❑
Applicant attests that his State of California Contractor's License #
is in full force and effect and properly authorises this application.
San Jose City Business License #
Form 280-1