401 NO. STREET LOT NO.
W e( APSEP
- PLICATIdN„FOR BUILDING PERMIT
o I CITY'OF CUPERTINO
9
Va 2 r 1967 Sanitary No.
5
_ Date 196_ Permit No. Tw
` o P'5ga nis n•rl+r
oa Application;she`ebylmad �d��alrpermrtto
i N a story,Type Building
aw
,w. to be occupied only as in accordance with
20 Plans, Specifications and Plot-PI n filed herewith. PI Ck Fee
,'_ 3 Estimated Value of Improvements,$3 0 Fee$
i J It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
J Z all other laws applicable to the construction, location, and use of buildings within the City of
0 Cupertino wiil�be complied with. _
3 < Owner x < ”'AL Il i+1.0 r�C jZ / G32
W Z Address �Jn iLNtA/�1
W a Byi� c>,-. Gt� �>E� <%✓�sl�� Address�iG�� /' I..T`>.`� /rL✓�
<02
0Phone 2 4� �'2� L Approved
State License BUILDING INSPECTOR