1955 p C )O7 •I. , LOT NO.--
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APPLICATION FUILDING ,PERMIT
AUG 31 1932 IF ERTINO`r
Date/�t /y I� T 195_ y ermit No.
A}1 'iCatidri is he eby?n ade ltA��lnp it to
i
a _story,Type Building
at
to be occupied only as i1/?.4
in accordance with Plans, Specifications'7d Plot-Plan filed herewith. o0
w Estimated Value of Improvements,$ Fee ' �•
Itis hereby agreed that the mquirgments,of the Cupertino Building and ,Zoning,Ordinances and
arBhy'
all other laws applicable to,the,construction, location,.and use of'buildihks within the City of
pertinowHl becompllied/�yitthh, _. 'J/ - •"•L -
ner_ t<�'� Address''-t
/ AddressCONTRACTOR, AGQNT- '�one 4 — 0 Approve
BUILDING INSPECTOR
RECORD OF INSPECTION APPROVALS
u
POUNDAT ON
DAT INSPECTOR
FRAME
DATE INSPECTOR
LATH and PLASTER —
DATE INSPECTOR
FINAL BLDG. -?T'`3
DATE INSPECTOR
FINAL ELEC.
DATE INSPECTOR
FINAL PLBG.
DATE INSPECTOR
j 3
3 FINAL GAS'
DATA INSPECTOR
t
� Y
I, the undersigned ereby, certify that
I am the owner and' o c_ ant of the single
family dwelling at ��VI SrrwR/Sc D, t ,:.
for which I am making application to do
CelyS%RUe-1-110 vt�ork as a homeowner.
I also certify that i vai11 not hire any
non-licensed C'OAll_,e�o2 or con-
- tractor, but will do- this wor myself.
:' TELEPHO NUMBER SIGNATURE