1486 (2) tL NO - V
NO. STRSHT
APPLICAkoTf N FOR BUILDING PERMIT
ITY OF CUPERTINO
Date_ 195_ Permit No.
Application is hereby made for a permit to :,44Ce
a story,Type zr ' / C[e a 61 Building
at
to be occupied only as
in accordance with Plans, Specifi ions and Plot-Plan filed herewith. Ole)
Estimated Value of Improvem ts,
$
7 i O Fee$
It is hereby agd that the requirements of the Cupertino Building and Zoning Ordinances and
all other laws ap�j licable to the construction, location, and use of buildings within the City of
;j Cupertino will be complied with.
u d-�
Owner. Address
`- By � ift Address—
J CONTRACTOR, AGr:NT "
It Phone r 1`. r.�— �'���� Approve
BUILDING INSPECTOR
RECORD OF INSPECTIO PPROVALS
DATE 1 SPECI'OR
FRAME
DATE INSPECT R
LATH and PLASTER
D T6 INSPECTOR
FINAL BLDG. � ,3d 6L �
DATE NSPF.CTOR
FINAL ELEC. `5 3a rL
DATE INSPECTOR
FINAL PLBG.
DATE INSPECTOR
FINAL GAS
DATE INSPECTOR
•s., 'A wU
T, the undersigned do hereby c rt"� , that I am
.`
the owner and occupant ,of*the single family do�elling• 2�."
for which I an making
application to do� or's as a homy camcr,
I also certi£'y that .;til r.o .re ai;v 1101:- iic�;.sec.
or contrr.ctor , but w
illdo this work myself.
TELEPHONE NUi?BERZ SIGNi!.TME
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