100079 020 ( / ` '-J
LOT NO.
NO, STREET
W AUL
fATION FOR BUILDING PERMIT
x o —00Q& OF CUPF.RTINO
Q LL
o Sanitary No.
5 a
U
i o
Dat 6_ Permit No. !C04n 11379
`o < Application is hereby made for ermit to ,
i U) a stcWj % Ilding
to be occupied only as �'�'�C'colKlfift"1.I�r
0 o Plans, Specifications and PI Plan file a with.00 Pl Ck Fee
> w �ss 00
F g Estimated Value of Improvements, $ ��� Fee.f Q2
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.
3 <
_ N Owner � � -� � " Address
Q a By //,5 Address
of
A U Phon .S Approved
State License BUILDING INSPECTOR /