682 LOT NO.. -
NO. STREET j 1`
AP LICA-- ' .FOR BUILDING PERMIT
*A
CI ?OF CUPERTINO
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D Tj ermit No.
' 0414;Applicatioh is hereby made for a permit to
story,�Ty,Pe, Building
V.,
to.be occupied only.as '
`'in;acco dance,with;Plans; Specifications and Plot-Plan filed herewith. m� '
Estt-m�ateJValue of Improvements,3'3_ ®0 'J Fee$
y It�I, shereby agreed5that the requirements of the Cupertino Building and Zoning Ordinances and
u�,alotherlaws app'lica6le to the construction, location,'and use of buildings within the City of
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u.wgu rtmo will.pe complied with.
nprOwner s/ ,i Address
By' Address L.I + .t.
CONTRACTOR,.AGENT
Phone _y Q6 / Approved
Ips,,'• '. - BUILDING INSPECTOR
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I, the undersigned.d0.hereby certi£y'that 'I em ' '
the owner and occupant of the• singl% amily dwelling at
1fZ(:, S S'" ��/�( At. £or which' I am making
application to do J �S a
o ,work as home owner,
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also certify that I will not hire any non licensed
or contractor, but will do this-work myself,
TELEPHONE NUMBER SIGltATURE .
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