63642 854 Lily Ave
Trac+ No. 5 3G Lot No._/L
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICPyTION FO BUILDING PERMIT 36�yZ
Date 19�/$� Permit No. -f
Application is hereby made for a permit
a
story, Type Pvo Building Use Zone te—
a+ S�� L/L�f��/!/i� �U� iP/3/yt? Occupancy J_
to be occupied only as Or7 poo Parking Space
v 7 Fire Sprinkler
in accordance with Plans, Specifications and Plot-plan filed herewith.
Estimated Value of Improvements, $.TS/2G'• 4t e
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any manner sops to violet the workman's compensation laws of California.
Owner ` G --Address '�/� f ("1;1 77AQ
By AddresslZA /" 77
`.fin ��REpCORD OF INSPECTION
Foundation
2 • 31, G 9 RW% Frame t
Stucco Finish
854 Lily Ave Young -
Exemption from requirement for State of California\forC ,atractor's License is hereby claimed by applicant: J
as owner ❑ statement filed j�'�—�
Applicant attests that his State of California Contractor's License #— �• Q "' �ir
is in full force and effect and properly authorizes + i pplicaiion.
San Jose City Business License # / TZE
s
Form 280-1