62119 7398 Rollingdell Drive
Tract No. Lo+ No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date 19Permit No. 2_14�
Application is hereby made for a permit to &1_4041 A925
a_ _ story, T -Buildinum Use Zone
at OccupancyPark
be occupied only as in 5 ac Z
n accordance with Plans, Specifications and Plot I fid h it i. o
in
Estimated Value of Improvements, $ &4900`— /Ze'
I certify that in the performance of the work for which this permit is issued I shell not employ any person
in any manner so as to violate the workmen's compensation laws ofCelifornie.
Owner f �Z Address 3 g 1�/�-r'TT-�•'"" y!
By l/'<% cAddress
RECORD OF INSPECTION p /j
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Foundation
Stucco ,
Finish
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