1967IAT
f'
�Vj CoOTAPPLiG�A 17J61 FOR BUILDING PERMIT
SIi�{�v OF CUPERTINO o
'SEP 11 1P�2•.: 195_ 4 Pernit�No. r 6?
Date /c
�+ licfA6 UPER ,,ermitto �
a L �YV1l stooryy,,Type[� e 1Y12e\\ BuildingBuildin
at ' ` O �f Q e �t 0 v.
to be occupied only as_��
in accordance with Plans, Specifications ind Plot -Plan filed herewith.
Estimated Value of Improvements, $ Fee $
C: It is hereby agreed_that the requirements of the Cupertino Building and Zoning Ordinances and
all other laws applicpble to the constru on, location, and use of buildings within the City of
"I Cupertino will be c r . 'ed with:
i 40,A-
v� Owner ` __ ddress
RECORD OF INSPECTION APPROVALS
FOUNDATION
DATE .61'SPECTOR
FRAME
DATE
INSPECT00. ,
LATH and PLASTER
INSPECTOR
FINAL BLDG.
Djft
INSPECTOR
FINAL ELEC
DATE
INSPECTOR
FINAL PLBG.
FINAL GAS
DATE INSPECTOR
DATE INSPECTOR ,
l
I, the- undersi�peed,,do'hereby tify that"'`
I 'am the .owner and occu�ant �f the sine
family dwelling at t m ,.
foich 1--am_making application to do
PtS iTq work as a homeowner.
I also c tify ha I will not'hire any
non-licensed or contractor,
but will do this w6xy myselP.
TELEPHONE NUMBER_ ._'_._