1300 (2)10-1111 1 �`
O (M� C1 LOT NO.
NO. STREET
AP ICATIO
FOR BUILDING PERMIT
j CITY'OF CUPERTINO
Date_ &;;w
Q5 Permit No.
A bcation is hereby made4o
p mit7t Fee C
a &-story, Type -
Vi C) C— Oy (e Building
e
at - S
A o J 2
to be occupied only as
r
c
in accordance with Plans, Specificatio d Plot -Plan herewith. 0O
mG
Estimated Value of Improvements, $
Lid Fee $
It is hereby agreed that the requirements
of the Cupertino Building and Zoning Ordinances and
v
all other laws applicable to the construction,
location, and use of buildings within the City of
;.j
Cupertino will b� mp' ith.
Owner
`//,eilX/d Die
AddressI;N
<n
By
Address
77 CONTRACTOR, AGENT
-1alr3ne K .Q — �lo�-9_ (i
_ Approve
ECTO
RECORD OF INSPECTION APPROVALS
I --ij�
FOUNDATION
DATE. INSPECTOR
FRAME
DATE INSPECTOR
LATH and PLASTER
/ "DAT INSPECTOR
FINAL BLDG. /VAI -D
D 6 14 1 INSPECTOR
FINAL ELEC.
DATE INSPECTOR ,
FINAL PLBG. 1
DATE INSPECTOR
FINAL GAS
DATE INSPECTOR
I, the undersigned do hereby certify that I am
the o,,-mer 'and oc t:pant of the single fa qil --welling at
2 11 � , C UJ for which I am making
application to do N� k as a home owner,
I -lso certify that I Trill of hire any non-licensed
RNTqr contractor, but will do this :Toric myself,
KV
TELrYF?offer .:IL': 3752 SI :iTm