NO PERMIT NUMBER � R
ll�' the undersigned to hereby- certif 'that�;I. arr
the ormer and occupant of the sin�,le fn,-cily°dwelling at
1,l 20 �.. �
L �oJ U,-• A �/ for w ,ich I'
am::making
l_ ...
ap_r.;].icatien to c'.o ?r
RjR f�? �e work as a l orae 'oimer.
I also certify t1,at I will not hire any nor.-licensed
o.r• centractory but wx11 ;!c this �/�
TUEPH01,1 ,iliA E FR ' SIGNA^U?E
/o R R-d A f? . LOT NO.
NO. 'STR ET
® APPP. LRATIOpN FOR BUILDING PERMIT
`'•I'TY
OF CUPERTINO �J
)ate IOOCT201%0 Y �• 195_ Permit'No. �Oy
Ap licatCn is hereby made for a permit to
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af r�_S�I-I ly�TIISW' o x ailo revelAding
at O 8 L resod A �tC
to be occupied only as 10 >< 2 R 1 t 0 Q lZ.
in accordance with Plans, Specifications and Plot-Plan filed herewith.
3cc.)
Estimated Value of Improvements, Fee$
v
� It is hereby agreed that the requirements of the Cup rhno Building and Zoning rdinances and
all other laws ap I'cable to the construction, location, and use of buildings within the City of
Cupertino will b a li with. /)
� Owne dress
/(/
..- Ely Addie
ONTRACTOR, AGENT
Phone L _2 i App °
I BUILDING INSP TOR
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