59473 11.43 Hollyhead
Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
A / _ APPLICATION FOR BUILDING PERMIT O� d
Date—LV�lY 19 G Permit No / Y�3
Application is hereby made for a permit to h O
a_story, Type Bu' A Use Zone I Q G
Occupancy y
^ A �
Parking Space 'Z—
to be occupied only as ' d"herewith. �%in
in accordance with Plans, Specifications and ot- n file
Estimated Value of Improvements, $
I certify that in the performance of the work for which this permit is issued I shall not employ any parson
in any mannay es toA lets{ e`workm s compensation laws of California.
Owner yg�yy� Address ��� 3
BY- L`'�y�rY —
Address AP
RECORD OF INSPECTION
Foundation Q � , Frame,
Stucco / '� `<° J !f Finish Z'�— �L.�.�Ct.o
1143 HoLlvhead 9 W. Donohue
Exemption from requirement for State of California for Contractor's License is hereby claimed.by applicant:
as owner, ❑ statement filed ❑ p ,
Applicant attests that his State of California Contractor's License #.L/ '� / S
is in full force and effect and properly authorizes this application.
San Jose City Business License # �:f D Z 7 o
Form 280-1 2/68 1OM