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52629 (2)
7611 Hollanderry Tract No. Lot No. CITY OF SAN JOSE BUILDING DEPARTMENT APPLICATION FOR BUILDING PERMIT Data 67 , 19_ Permit No. 5—Z- 6 Application is hereby made for a permit to a dA a �story Type t,..�t 'I4ing Use Zone at /✓� Occupancy_ to be occupied only as C /� Parking Space 2� in accordance with Plans, pecificatio s lott�y'r^• a Sprinkler -- Estimated Value of Improvements, $ ©0 a 'Y Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned: as owner ❑ statement filed ❑ Undersigned attests that his State of California Contractor's License # is in full force and effect and properly authorizes ihisyapic�ion. San Jose City Business License # !V U h� I certify that in the performance of the work for which this permit is issued I shall not employ any person in any man er so as to v,.Iqjg the workmen's compensation laws of California./ Owner ' Address 76// /Y-v -. A Jvre E+y By Address-?S/ M 7611 Hollanderry Leland Stayrook /— RECORD OF INSPECTION Foundafion Stucco Finish Form 2801—10M—5/66