1090 (2) (TO✓�l!/ ��� ""� LOT NO
STREET
PPLIC ITIOON FOR BUILDING PERMIT
��".•''"�� C-I .Y UPGRTINO
Date 19 Permit No. ge)
If
V
Application is hereby made for a permit t
aCi
INIT'forly Building
at TI
to be occupied only as
n accordance with Plans, S 'e ' ITS a�nd7�P�lot-OPlat filed herewith.
Estimated Value of Improvements, $ .JW '�'V fee$�
v
It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
all other laws a licable to the construction, location, and use of buildings within the City of
Cupertino will ompli with.
v
Owne Address
L
By /nom Address
nc
Pho /// 9� F.NT
Approved
I BUILD NG INSPECrOR
RECORD OF INSPECTION APPROVALS
FOUNDATION 1
DATE INSPECTOR
FRAME
DATE INSPECTOR
LATH and PLASTER
DATE INSPFC.TOR
FINAL BLDG.
Dn-re/ INSPECTOR
FINAL FLEC.
DATE INSPECTOR
FINAL PLBG. 1
DATE INSPECTOR
FINAL GAS
DATE INSPECTOR
T �
I," the undersigned do heret-j certify that T_.am
the owner and occu/p?nt of the single family dwelling at
Of r which I am making
application to do o i, work as a home owner.
I also certify that I will not hire any non licensed
or contractcr, but twill do this work myself.
'r, a( HONE NuijILt SIGT? TUFE