1281 F.
LOT NO.
1 APKI TION FOR UILDING, PERMIT
CITY OF CUPERTINO.
•. „ Date { � eJ1�9 1 Permit No.--/
D
Application is her�ebay made forna,"Permit toil wZ
'. a - e- story,TYPe. . • �� " �' ilding
to be occupied only as
L in accordance,with Plans, Speci tions and'Plot-PlanQed herewith. OQ
1
Estimated Value of Improvements, WS Fee$ 9i
It is her y greed that the requirements of the Cupertino Building and Zoning Ordinances and
all othei law• applicable t the construction, location, and use of buildings within the City of
'Cupeitino w' be plie it a
,In Own '.Address
x
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I3 r Addr
P CONTRACTOR_, AGENT
ne y
�' Approv
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WUILDINGNSPECTOR
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I, the undersigned, do hereby certify t
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the Duper and cup,nt of The single' £anvil duel+lnrrat
/D for which10,
^'^I am nig �nn1�
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application tc ork as a home dimer.
I also certify that I will not hire any non-licensed
or contractor, but ,Y1 do this work myself.
TU I,THONE NUMBM- SIGNATURE