2984 1 i.OT NO. 19
NO. STREET ,
w p �y �APPLIC/ TI FOR' BUILDING PERMIT
s. ° l�
OF CUPERTINO
3 U /OCC 2 7 12 �
� Sanitary No.
Date I L G 196_ Permit N 1 I�
° nttnr TtTt
a a A'�pllcat ;.is hyrLetl�y�iade fora permit.to
i
to aIff `—story,Type Building
a w
,�. to be occupied only as
a
00 in accordance with Plans, Specificationff ina P{ot-Plan fled herewith.
3 Estimated Value of Improvements, $ (A0, OQ Fee$ 1 OG
z J It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
J z all other laws applicable to the construction, location, and use of buildings within the City of
o Cupertino ll cot 'ed '(h
3Q- Owner Addres 6y4 � l qtr.
0
a By Address
s
° Phone r-2-�`-5 J d 5� _
Approve
State License.4�0�� BUILDING INSPP&OR
RECORD OF INSPECTION APPROVALS
FOUNDATION 3
DATE, INSPECTOR
UNDERFLOOR _ 3
DAl'E INSPECTOR
FRAME �—
DATE INSPECTOR
,LATH an ;PLASTER 3
DATE INSPECTOR
FINAL BLDG.
DATE INSPECTOR
-FINAL ELEC.
DATE 1 PECTOR
FINAL PLBG.
DATE INSPECTOR
FINAL GAS
DATE INSPPCl'OR
CERTIFICATE OF ' COMPLETION
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
Date ............O ......... ....... Building Pernnit No.�//Ilr-
ne Building Located at
Owned by ....Z. ----- .......
h......_......_.. .. ........ ........
Fomit
Has Been �P��se As: .........._Altered)
. .. ............... ....... ................
.......................... ....................... ----------- .......................... ...........................................
............................ ....................................................................................................................
.......................................................................... ....... .... ............. ...............
102 1/63-500 ,��BUILDING INSPECTOR