945 (2) -,117 Mr Cle
APPLICATIOlra�jt ING PERMIT ^^AA
CITNO 1`/b`Z.r- •'fie` . .�'
Date G - a $ Permit No.
Application is hereby made for2GC i
a0Q- story,Type . y Building
clat Me. CIsZtla TZ-cA , Cts eGt► tt .
to be occupied only as (.)—1 -' 1 t i u Ven p.A
in accordance with Plans, Specifications and Plot-Plan filed herewith.
' Estimated Value of Improvements,,�L'�+ Fee$ 16`10
' It is hereby agreed that the requirements of the Cupertino Build,nnnqqq and Zoning Ordinances and
all other laws applicable to the construction, location, and use puddings whin the City of
Cupertino will be complied with. /
Owncly ' Addr oS Me-C I P I ti",
Dy D Addres
3 CONTRACTOR, AGRNT
a Phone• �L `el' '9Ys"9iT Ap ` r
BUILDING IN ' TOR
RECOR S TION APPROVALS
FOUNDATION
INSPECTOR
FRAME s
INSPECTOR
A and PLASTill
DATE .INSPECTORY
FINAL BLDG. I I - I��- C , :1 �� 1, 1
• DATE - '1 INSPECTOR
FINAL ELEC. i
DATE E . INSPECTOR • }
FINAL PLBG.
DATE INSPECTOR
FINAL GAS
DATE INSPECTOR
he undersign d""co Hereby certify that I ^m•
the owner 'and occupant o£ the s'
w,n. F i. le family dwelling at
9£or which I am making
application to do Cfa 2, Q/�JLVfrk as a home ovmer.
I Ilso certify that I will not hire any non licensed
�R Q7, contractor, but vrill do this work myself.
TEi,EphOiVE i�ITNBE.R SIGi�?ATURE
1. undersigned db'li +eb .rchrtify 1i
Y m
tY e.off ner and occupant of 'y ;e single family dwelling a t
a
_<rs y/ or which I am making
application to. doork gas a home owner.
I also certify that I•will not hire an; non-licensed
^ �c� Cl1Cor contractor, but will do this work myself.
TKEIIHONE b TYIJIB it
: SIG UTURE