209 4 C) � t ` ✓Q JZ 4ACk `t V�/�-FOT NO.
NO. STREET
w APPLICATION FOR BUILDING PERMIT
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= G CITY OF CUPERTIN
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Date Y — 7 196`- ' Fermit o.
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oApplication is hereby made for a permit to ���e-
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' „� . / swcy,-Type .� r X �+ Building
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o be occupied only as "
00 in accordance with Plans, Specifications awn q(ot-Plan filed here t �O
- ;Estimated Value of Improvements, $ J C�� Fee$`tet
zJ It is hereby agreed/tllt the requirements of the Cupertino Building and Zoning Ordinances and
J z all other laws app{{cab It the co tion, locatiop, and use of buildings within the City of
j O Cupertino will be m ie i
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_ m Owner Address
W a By Addres
<u Phone�a'I2^ — APpr
State Licens BUILDING INSPE OR
RECORD OF INSPECTION APPROVALS
FOUNDATION
DATE. INSPECTOR
UNDERFLOOR
DATE INSPECTOR
FRAME
DATE INSPECTOR
LATH and PLASTER
DATE, INSPECTOR
FINAL BLDG. G 1
DATE INSP
FINAL ELEC.
DATE. INSPECTOR
FINAL PLBG.
DATE INSPECTOR
FINAL GAS Admkk
DATE INSPECTOR