1300 10-1111 1 �` O(M�C1 LOT NO.
NO. STREET
APICAYIO FOR BUILDING PERMIT
CITY'OF CUPERTINO
Date_ &;;w Q5 Permit No.
A bcation is hereby made4op mit7t Fee C
a &-story,Type - e Vi C) C— Oy(e Building
at - S A o J 2
to be occupied only as aW r
c
in accordance with Plans, Specificatio d Plot-Plan herewith. 0O
mG
Estimated Value of Improvements,$ LYS Fee$
It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
v all other laws applicable to the construction, location, and use of buildings within the City of
;.j Cupertino will b � mp ' ith.
<n
Owner AddressI;N
`//,eilX/d Die
By Address
77 CONTRACTOR, AGENT
-1alr3ne K •A — �lX9,C) _ Approve
ECTO
RECORD OF INSPECTION APPROVALS
I --ij�
FOUNDATION
DATE. INSPECTOR
FRAME
DATE INSPECTOR
LATH and PLASTER
/ " DAT INSPECTOR
FINAL BLDG. /VAI-D
D 6 14 1 INSPECTOR
FINAL ELEC.
DATE INSPECTOR ,
FINAL PLBG. 1
DATE INSPECTOR
FINAL GAS
DATE INSPECTOR
I, the undersigned do hereby certify that I am
the o,,-mer 'and oc t:pant of the single fa qil --welling at
2 11 � , C UJ for which I am making
application to do N� k as a home owner,
I -lso certify that I Trill of hire any non-licensed
RNTqr contractor, but will do this :Toric myself,
KV
TELrYF?offer .:IL': �]S2 SI :iTm