3025LOT NO.
/ NO. STREET
z APPLICATION FOR BUILDING PERMIT
cr
Y ° CITY OF CUPERTINO
a / SanitarY No.
W = Date_ l 19�L
gP '.No
o a Application is hereby made for a permit to
i to a- story, Ty Building
QW Q
ato be occupied only as
0 o in accordance with Pla , Specifications and Plot -Plan filed herewith.
>a 9
Estimated Value of Improvements, $O Fee $
i 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
=! o Cupertino will be complied with.
Owner % ��,Address /
W Z !
W By Address
t o Phone_ 2 S 3 Approved&39,C��. 0
J1
State Licens BUIL ING INSPECTOR
RECORD OF INSPECTION APPROVALS
FOUNDATION
DATE. INSPECTOR
UNDERFLOOR
FRAME
LATH and PLASTER
FINAL BLDG.
FINAL ELEC.
DATE INSPECTOR
DATE INSPECTOR
FINAL PLBG.
DATE INSPECTOR
FINAL GAS
DATE INSPECTOR