958 (2) L� LOT NO'
X40. STREET.
I I., FORBUILDING PER
^ MITi
a p� p T-
T
OF CUPERTINO 1
1
Date 'r DCT o . 195_ mit No. ,
a 6(A� licc�ation is,hereby made for a�j�to
r o'stOPIPP�t "t7�7•`— Building
at
to be occupied only asy
in accordance with Plans, Spelfications and Plot-Pled herewith. 00
v
Estimated Value of Improvements, Fee$ 18
� It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
all other laws applicable v the co uction, location, and use of buildings within the City of
;-j Cupertino will complied w/�
Own �/ ^ Address
Address ef
CONTRACTOR, AGENT
e -Z - 75 7v Approve
If'� BUILDING INSPECTOR
er-
' � u ire
G U V V C
d 2�1�0
CL
a �c�
Z
LUK
Z
W F
C � m faA W W U I N
. �w� w
I the'uridersigned_do hereby C"
that I,am;
the owner :,anc�] occupant of thhe] 'single' family 'dwelling at
;/0.2.6.9. ( �O.,f. .�� `.,��', 'for which'I am -,r[1kina,
application to do` 1 ork as a home owner.
I also certify`that"I will not hire any non-licensed
or contractor, but,`wll, do this work myself.
TELEPHONE NUMBER C-//'/ ., SIGNATURE