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10572 I CED.A,R TM �1„BT LOT NO.
NO. STREET
W z APPLICATION FOR BUILDING PERMIT
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Yo CITY OF CUPERTINO
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o a Sanitary No.
W 0 s/_ LL Date 196_ Permit No.
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Application is hereby made for a permit to erect
a
N a one story, Type 5—I Building
W SFDW
W
M to be occupied only as
0 o in accordance with Plans, Specifications and Plot -Plan filed herewith.
F3 Estimated Value of Improvements, $ 19,000.00 Fez $ 00.00
z J It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
* Z all other laws applicable to the construction, location, and use of buildings within the City of
2 O Cupertino will be complied with. 1200 So. Highway 9
3 a Owner BLOSSOM VALLEY HOMES, INC. Address SM Jose Calif.
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rc a By Address
a o Phone cz�_ J 7 3
U 196-617 Class B-1 Approve
C}t State License ��Nc INSPECTOR
RECORD OF INSPECTIO
FOUNDATION , -,
DATE
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DATE INSPECTOR
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DATE �.� INSPECTOR
FINAL BLDG. < < LD r
DATE INSPECTOR
FINAL ELEC.
FINAL PLBG.
INSPECTOR
INSPECTOR
FINAL GAS
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