69819 (2) 7441 Rollingdell Dr. 1 .7 /a s�
Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
p APPLICATION FOR BUILDING PERMIT
Date_L! ' 2- , 19 ?/' Permit No.��L�
Application is hereby made for a permit to a,4e
a _story, T e_ v Ln g�-�q--Use Zone R_�
at7 �Y _ /v(/ Occupancy_
Pa�g Space
to be occupied only as _a inin accordance'with Plans, Specifications and P o Efner. Elect. �—
Estimated Value of Improvements, $ 1
I certify that in the performance of the work for which this permit is issued I shall not employ any persg
in any manner so as to violate the workmen's compensation laws of California. �7
Owner,�y�'/ —GdC AddressyL!/`'�•`�
g /�,/ ��� Address / l -
y /
r // RECORD�OF INSPECTION
Foundation \ Ib' 1 �' 9� Frame, ?1 �n�}
Stucco Finish
7441 Rollingdell Dr . 7 chaffuner
F—
Exemption from requirement for State of California for Contractors 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 authorises this application.
San Jose City Business License # r 01" 6 1� q
Form 280-1 5/70 IOM