464IV e
Date
NO. STREET '
APPLI ATIO
�ci
VAR 11 1968
Ap,lictationt t
,plication
T115sel
( I I
FOR BUILDING PERMIT
'F CUPERTINO
rSanitary No.
6_ Permit No.
ng
to be occupied onl
Plans, Specifications and Plot -Plan filed herewith P1 Ck Fee
Estimated Value of Improvements, S_QZOb Fee S ��
It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
all other laws applicable to the construction, location, and use of buildings within the City of
Cupertino will be complied with.
Owner DI n-ECZ_ 12 EALT ?/ Address 1"3 10 5,kt'La* , A JC
Phone %! SC - 91
State License
INSPECTOR