76317-F (2) 7626 Hollanderry Place
Tract No.-s9579 Lot No.�
CITY OF SAN JOSE BUILDING DEPARTxQ�
APPLICATION FOR BUILDING PERMIT {�1�
Date — 1.6-- 11973 P r � No. 74 ,411�r
Application
- is hereby made for a permit to
at `7o' (y TYP7�d� �n Occu se e —f-�
` n P Y�
to be occupied only as!�s/mP'!( ��( YBnL Parking Space —
in accordance with Plans, Specifications f.p,, r---Fi a Sprinkler
�. Elect.
Estimated Value of Improvements, � DO
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any men er so.as tIo�i—olafa the workmen's compensation laws of California.
Owner D1i/ I�.cL.�Y Address 7�G� BOLL-A—M E)w �L
B2Foun
20L/Nf} X00 LS Address/17-e /iSEO L.goH
RECORD OF INSPECTION
io J /\ Le�( rame
Finish
7626 Hollanderry Place Don Kelly i /�
Exemption from requirement for State of California for Confractor's License is hereby claimed by eppli en4:
as owner ❑ statement filed ❑ /p /''�}'"`—'
Applicant attests that his State of California Contractor's License #'�(7 /. [T '—li 673
is in full force and affect and properly authorizes this application.
San Jose City Business License # A1 3
Form 280-1