89466 7895 BELKNAP DR.
Traci No. Lo} No. IJBC 1973.
CITY OF SAN JOSE BUILDING DEPARTMENT
G APPLICATION FOR BUILDING PERMIT �q4
Date \ 1 K , 19 —\ 5- Permit No.
fob
Application is hereby made for a permit +o C��
a , story, T�y(ppe )di Use Zone
at
q 15 Occupancy
to be occupied only as_ �' Parking Space
in accordance with Plans, S e if ons and PI I ¢i1 Fire Sprinkler
er. Elect.
Estimated Value of Imp eme'nts, $ /
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any manner so as to violate the workmen's compensation laws of California.
Owner 'mrA'01 —U uVO Address -1801 Q;�)E.LfCh� P
By Address / 1
RECORD OF INSPECTION
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1. L_OCATIO - 2.DATE RCD.. 3:TIME RCD.
.� '4.READY AM ( ' ANYTIME&) S.TYPE OF 6.AREA 7. 'IN PT.MADE ZS
PM I 1 SPECIFY NSPECT. TIME Z
r,14 1. DATE
III 8.APPROVED (' 9.REMARK -
DISAPPROVED 1 1
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INSPECTOR
` 280 671
WHITE-FILE YELLOW;INSPECTOR � PINK-OFFICE
• I LOCATION � �r 2. DATE RCD. 3.TIME RCD.
• ` 4.READY 'AM ( 1 ANYTIME.( ' 1 5.TYPE OF 6.AREA 7. INSPT.MADE 50
PM ( 1 SPECIFY -INSPECT. TIME
DATE
• 8.APPROVED �1 1 9.REMARKS: /
DISAPPROVED ( 1 /6 cher
t77 I
.I .. INSPECTOR
280-671
WHITE-FILE YELLOW-INSPECTOR PINK-OFF,ICE.'