51400 (2) 7642 Hollanderry
Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date T , Ig—S6) Permit No.
Application is hereby made for apermit to
a story, Type �� IGFs W/ 7B51din w Use Zone
at (DL ;f2/Z Occupancy f
to be occupied only as " fAW ,Parking Space 7
in accordance with Plans, Sp ifications and Plot-plan filed herewith. Fire Sprinkler
Estimated Value of Improvements,
Exemption from requirement for Slate of ali orfor on}rector's U en a is hereby claimed by undersigned:
as owner ❑ statement filed ❑ O
Undersigned attests that his State of California Contractor's License # —���
is in full force and effect and properly authorizes this appll i n.
San Jose City Business License # U 4
I certify that in the performance of the work for which this'permit is issued I shall not employ any person
in any mann r so as + viola}e the workman's compensation laws of California.
Owner D Address'7(.11-2-
By Address-:�Y/ 7 M-P
S `'
7642 Hollanderry H. `porton
�� RgECORD OF INSPECTION
Frame
,N�cO Finish
Form 280-1—IOM-5/66