50775 (2) 7441 Rollingdell
Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
7 7;- APPLICATION FOR BUILDING PERMIT
Date / - G , 19 & �P Permit No.
Application is hereby made for a permit to AD 2 Tn
a story, Type. Building— y� Use Zone
at -7 4 Cf I Pn i Occupancy f
to be occupied only as lEequy I L4f 9� Tia Parking Space 2_
in accordance with Plans, Specifications and Pr - Ian filed herewith. AFire Sprinkler
Estimated Value of Improvements, $
Exemption from requirement for State of California for Contractor's License is hereby claimed by undersigned:
as owner k., statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes this application.
San Jose City Business License # I '
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any manner�(-A
so as to violate the workmen's compensation laws of California.
Own � d VI M C/C Address
By hh t4A41W44 Address
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