91821 (2)7683 Shadowhill Lane
Tract No. -Lot No. UBC 1973
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date rIts
& , 19 Permit o..
Applicationereby madefo ermit toastr
a+ 76S.0
to be occupied only a
in accordance with Plans, Specifications and 'lo# -plan a ere re Sprinkler
Estimated Value of Improvements, $ ,-12<pn nm Emer. Elect.
I certify that in the performance, of the work for which this permit is issued I shall not employ any person
in any aannnner �so s to viola th t �e workmen' 9 compensation laws of California.
Owner/>L _ Address
By Address
RECORD OF INSPECTION
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