01209 (2) .7653 PEACH BLOSSOM DR.
Tract No. Lot No.
CITY OF SAN ROSE BUILDING DEPARTMENT
2 APPLICATION FOR UILDING PERMIT
Date y- — 19 Permit No. G�2 U
Application is hereby made for a permit to ��o T�,�Y ST
a�_story, Type — BOA' Use Zone .4— /
at /G / _ Occupancy
to be occupied only as[�flvr�r Par�J'n,i Space 2
✓. ,/ IF
jre�Sp rr nkler
in accordance with Plans, Specifications and Plop-pan file` erewrf • E'mer. Elect.
Estimated Value of Improvements, ; /z, 96)C)
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any manner so as to violate the workman's compensation laws of California.
Owner 1 '/124CZfAL.Akddress
e0 � Address
�yG(/ q�RECORD OF INSPECTION
Founda#ior( Frame 3—CLl- �_•:`_�5�.�.�`h.�
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Stucco
',_ !`..Finish 3- .i�- -� ,✓%11�:' �_-�"'
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260-601N
7653 PEACH BLOSSOM DR. E
Exemption from requirement for State of California for Contractor's License is hereby claimed by applicant:
as owner
❑ s1.f.me.f filed ❑ 2SSI 4 9
Applicant attests that his state of California Contractor's License #
is in full force and effect and properly authorizes thisplication.
Sen Jose City Business License #
a = 'T ;U
V
11
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280-601
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