2495OT NO.NO. STREaT
W i APPLICATION' FOR. BUILDINGa PERMIT
so
Q ° t; CITY. OF.-CUPF.RTiNO
O J
� a �.';-� -•� ' / Sanitary No.
U
i ,� Date ��? 196-3 it o.
1 ° �Xn—,
'o Q Application is hereby mad or r.it t /
Qn —Z story, Bui ing
to be occupied only as
Jo o in accordance with Plans, Specifications and Plot-Plan filed herewith.
3 Estimated Value of Improvements, $ :rn — Fee $1i'10 1"E45
zJ It is hereby agreed that the requirements of the Cupertino Build' g and Zoning Ordinances and
J z all other laws applicable to the construction, location, and use buildings withine City of
d o Cupertin i complied tvi r /
3 r
_ N Own Addr
w z
W By Address D
a � Ph°n pt
Approved
State Lice _ BUILDING INSPE.C'1'OR
RECORD OF INSPECTION, APPROVALS
FOUNDATION
DATE .�i ;; INSPECTOR
UNDERFLOOR
DATE. , INSPECTOR
FRAME
LATH and PLASTER
FINAL BLDG.
FINAL ELEC.
FINAL. PLBG.
FINAL GAS
DATE INSPECTOR
DATE .INSPECTOR
DATE Il� INSPECTOR