3004 /° �� •' I LOT NO. ,
TRE T
W ¢
E
T OR BUILDING PERMIT
° �A�/ 2 6 �96a OF CUPERTINO
OJ
p � Sanitary Aro.
5 a
00
_ „ U;tjo In' 196_ /1 Permit No/
° l�� jNrQ at a�lu.ci�
o r Application is er r permit to
a
i In a story,Type �-1- Building
a W r
to be occupied only as L
0 o in accordance with Plans, S ifications and Plot-Plan filed herewith.
> cro 00
F g Estimated Value of Improvements, S r�0O0� 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
d 0 Cupertino a/�,I bepmplic with. //
3 m �wner / I {I 1 Address ./O)Z'7�. L t f/��
W2
W
EL By c Address
a 0 Phone Jl -64'x-L Approve G
ry State Licenk� A _ BUILDING INSPEC Oft
C _
�L RECORD OF INSPECTION APPROVALS
F ATION 1
DA v INSPECTOR
Ur�4FLOOR
DATE: J4SPFCTOR
FRAME 20 — t
� cDATE. INSPECTOR
.ATTH"oK PLASTER
DATE INSPECTOR
FINAL BLDG.
/ DATE INSPECTOR
FINAL ELLC.
D E INSPECTOR
FINAL PLBG.
DAT INSPECTOR
FINAL GAS
DATE INSPECTOR
the undersigned do hereby certify that
• I am the owner and occupant of the sin le
family dwelling atG� ,
f which am making a pa2cation to do
work as a homeowner.
I also certi y that I will not hire any
non-licensed er contractor,
but will do this work myself.
�/ Ib,aj
TELEPHONE NUMBER SIGNA I TORE