87507 1141 Hollyhead Lane
Tract Now-9-?P Lot No. UBC 7973
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date 6- 1111
, 11// , 19 germ,it No.
Application is hereby made for a permit to i
a_(story, Type Q 1it Use Zone
a} Occupancy
to be occupied only as Mi �,/� �@ `r Parking Space
in accordance with Plans, S ,ens an,d�}� erewjFVy
Fire Sprinkler
O fc- Emer. Elect.
Estimated Value of Improvements, $ :572 0
I certify that in the performance of the wd for which this permit is issued I shall not employ any parson
in any ma er so as to violate the workmen's com ensation laws of Califocr7nia.
Owner -� w .t Gd Q �/�(M•@Qe/ Address // �4f �� a,/'/'
By - S �— Address .2 /7vH yam/ t Ga aZ .4,
RECORD OF INSPECTI/ON aNFt. 6-30,7.r Rr8
oundation t LS- )S hi.��(S �- FFj,��1G�.s"s�'''""'�:
Stucco �•` Finish �' 12' 2'5- AX6
1141 H011vhead Lane T. B . Mungall C�
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 # { Z' 3 7a i —Al,/
is in full force and effect and properly authorises this application.
San Jose City Business License # i� ^ 17
Form 280-100 /-fn !(Nl« ,( 4ae,R. 4, s;_-7r- /.1o_o 0_. . _te r