51167.1 (2)I
r g: r/Jn -- LOT NO.
NO, STIIEET
r. PLLIIC=ATION FOR BUILDING PERMIT
CITY�OF CU_ PERTINO
111 Sanitary No.
2 ` 1967 1,
Date , - 196.2 Permit/No. J //% 7.
LPplination is heteby.rna.de for a permit to P/C['s�
uv Utjij H IN,
a ezw story, Type �� Building
to be occupied only as , f, Fes"• in accordance with
Plans, Specifications and Plot -Plan filed herewith. P1 Ck Fee ! /
Estimated Value of Improvements, $ z /lid/% Fee $ ✓3D
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 Address DI1Z-C1YA1JT
2295 DE: tA CRUZ RM
By / Address-cAddress-cAmTA Ici ARA CAI IF 95050
Phone Approved WILLIAM D. E=NEVICH
State License/ BUILDING INSVFCI'OR
J