75869 8121 Park Villa Circle
Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date 3--C 19 7 -3 Permit No.Z��GT
Application is hereby made for a pe mi to
a�—story, Type' r Buliding; _Use Zone .z
at � , yl Lz /.F= Occupancy f
arking�Space
to be occupied only as / �.�A/_ �� D�i WN l 'g Z
in accordance with Plans, Specifications and Plot-plan filed herewith.
Fire Sprinkler
n v Emer. Elect.
Estimated Value of Improvements, $—K� •�
I certify that in the performance of the work for which this permit is issued 1 shall not employ any person
in en to viol_atejh _r kmon's.compensation� of C �
Ovrny�t - 'J_ Address L eli{Iornia.�C( C/./ - l✓! '
Address
RECORD OF INSPECTION
Foundation Frame
Stucco Finish1 -
8121 Park Villa Circle Phyllis Seelbasry
Exemptionfrgm requirement for State of California for Contractor's License is hereby claimed by applicant:
as owner L✓JJ statement filed ❑
Applicant attests that his State of California Contractor's License #
is in full force and effect and properly authorizes this application.
San Jose City Business License #
Form 280-1