1936�omgl Ql
Ll M k 2e& t`� �, Q UT NO.
jj%141 �" kp .1 1 ON FOR BUILDING PERMIT
A IR, LTlr OF CUPEMM)-
D' O , 195_ Permit No.
ta��
TA plication i's
lhereby
[�m�ade for a per
Building
at n �)
to be occupied only as / 7
in accordance with Plans, Siecification)s and PIIpLPlan filed herewith. 141
u Estimated Value of Improvements, $ ! b n —O Pee ,$
y It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
all other laws applicable to the construction, location, and use of buildings within the City of
Cupertino will beeccomplied with. �t
ti Ownet�_r.+� G�'7�'—•z_ Address �/-
BY Address 3� S i •-�* /
���VVV���IIVJJJ CONTRACTOR, AGENT
Phon Approved
111111141 INSPECTOR
RECORD OF INSPE& ON APPROVALS
4
FOUNDATION
` DATE INSPECTOR
FRAME
FINAL PLBG.
FINAL GAS
DATE INSPECTOR
DATE INSPECTOR
DATE
INSPECTOR
LATH and PLASTER
DAT
INSPECTOR
FINAL BLDG.
DAT
INSPECTOR
FINAL ELEC.
DATE
INSPECTOR
FINAL PLBG.
FINAL GAS
DATE INSPECTOR
DATE INSPECTOR
i
I, the undersigled do hereby certify that
I am the owner and occupan �o the single
family 67vi6ll'ing at p�$� CC l
for which I am
I also cert work as a homeowner,
non -licensed y that I w—illll not hire any
but will do this wo 1 mys` or contractor,
TELEPHONE NUMBER SIGNATURE +