1014 NO.
PPRRRT Tt OR BUILDING PERMIT
MUPERTINO
Date 1 Permit No.
Application is hereby made for a permit
a---Z—f Lot' ypE� Building
at V' , 1J
0
to be occupied only as
in accordance with Plans, Specifications and Plot-Plan filed herewith. /h�
Estimated Value of Improvements,$AM2 Fee$ 27_% i o d�
v
C 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
,.=7 Cupertino will,be complied with.
54 in
Owner) Address JO to � f
By Address
CONTRACTOR, AGENT
1 j S Phone X7L —&, 009 Approved
6UILWNG INSPECTOR
RECORD OF INSPECTION APPROVALS
t
FOUNDATION
DATE INSPECTOR
FRAME
DATE INSPECTOR
LATH and PLASTER 1
DATE INSPECTOR
FINAL BLDG. _�
DATA INSPECTOR
FINAL ELEC.
DATE INSPECTOR
FINAL PLBG.
DATE INSPECTOR
FINAL GAS 1
DATE INSPECTOR
1 t.
I, the undersigned do hereby c!e-rtify that I zm
the'owner and occupant of the single £21ly dwelling at
o
£or whiAh I Fur, making
application to do work as a home owner.
I also certify that I will not hire any non licensed
4/z �� or contractor, but will do this work myself,
TEi EYhOiVE iNPII3FR S GNATL