9677 (2) 905 ROSE BLOSSOM DRIVE
Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date �/ a S . 119 71?� Permit No. D 9ti 7
Application is hereby made.fti a permit to / < 2o T>e w f,,,,�
a story'Type 6 Use Zone
at gOS /1 ose >(os rr7i- Occupancy
to be occupied only as /Fi+n Anes et 39.2
in accordance with Plans,Specifications and t- n fil erew' a ce
Estimated Value of Improvements, $ 713 yO •oo Fire prinkler
Emer- Elect.
I certify that in the performance of the work for which this permit is issued I shall not employ any person
� q
Owner c/ 4o, I dl Address
By ! 2 Address C(0,51 e F(& Vm DC,
This permit shall expire and become null and void if the work authorized by it is not commenced within
120 days from the date issued or if the work is suspended or abandoned for a period of 120 days after
commencement. �p,
FINAL INSPECTION T I� 1 rtt� `r�`-r '� 280-601N +
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Exemption from requirement for State of California for Contractor's License is hereby claimed by applicant:
as owner ]� I statement filed ❑ 1
'Applicant attests that his State of California Contractor's License No.
is in full force 4and effect and properly authorizes this application.
San Jose City Business License No.
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2. DAT CD.*o/ 3.TIME RCD.
4.READY AM ( I ANYTI �I. 5.TYPE OF 6.AREA 7. INSPT.MADE
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V DATE - i
8.APPROVED ( �. 9.REMARKS: -
DISAPPROVED 1 1
INSPECTOR
280-671
WHITE-FILE YELLOW-INSPECTOR PINK-OFFICE
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• 1.LCUCATION 2. DATE RCD. 3.TIRCDO
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• O ><) 9.REMARKS:
DISAPPROVED ( 1im
•
•
INSPECTOR
280-671
WHITE-FILE YELLOW-INSPECTOR PINK-OFFICE
O1,L ATION � 2 TE CD. 3.TI E RCD.
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• 4.READY AM ( L--l' ANYTIME ( I 1 5.TYPE OF 6.AREA 7. INSPT.MADE
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• B.APPROVED ( 1 9.REMARKS
DISAPPROVED 1�1
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• INSPECTOR CGL
280-671
WHITE-FILE YELLOW-INSPECTOR PINK-OFFICE
1. LOCATION - 2.DAT RCD. 3.TIME CD.
• � �ozz2 �� 1} 7%' i '
• _ 4.READY AM ( I ANYTIME 1 ) S.TYPE OF 6.AREA 7. INSPT.MADE
PM ( 1 SPECIFY IN PECT. TIME
N do!6 i DATE i i
• 6.APPROVED ) 9.REMARKS:
DISAPPROVE6 ( 1
INSPECTOR
• T- 280-671
WHITE-FILE YELLOW-INSPECTOR PINK-OFFICE
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• 1, LOCATI 2. DAT R 3.TI ERR,
• 4. ADV, AM ( I ANYTIME ( I 5.TVP OF 6.AREA 7. INSPT.MADE
PM ( 1 SPECIFY I CT. TIME
DATE
• 8.APPROVED ( K 1 9.REMARKS:
DISAPPROVED ( )
, v
INSPECTOR
•
280-671
WHITE-FILE , YELLOW INSPECTOR PINK-OFFICE