94886 (2) 1128 ROLLINGDELL COURT ti/OO�L ASG
Tract No.StT76J Lot No. T
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT T�
Date.7/�'U 19 7 C- Permit No.
ok plication is hereb for a permit to
a story, Type _ it ' Use Zone
at
// Z9 W4111,>l L. c:-- ancy_I
to be occupied only as,/ Z& PwSFaire S SPace e—M—
kler—
in accordance with Plans, Specifications an Plof- I filed herewith. Fire Sprinkler
—
in
,00'.1Z30 Errpr. Elect.
—
Estimated Value of Improvements, _ _
I certify that in the performance of The work for which this permit is issued I shall not employ any parson
in any mann r lb s t iolate t e workman's compensation laws of California. `/
Ow rP-`^. d i�Address� -SQiL AeF1COlq�v' aT
By�%d GL/�t�N Address
/ RECORD OF ISPECT
'Foundation Frame 1 1 176
2
Stucco
260-601N
Exemption from requirement for State of California for Contractor's License is hereby claimed by applicant:
as owner ❑ statement filed ❑
Applicant attests That his State of California Contractor's License # � �
is in full force and effect and properly authorise�s/}hi p pylicaafiioon_._,
Sen Joss City Business Liens � r/I'�aTi —
p�y-6 1,76 G�. i e e-
280-601 N � ' x