51015.2 NO. STREET
w ¢ APPLICATION FOR BUILDING PERMIT
° ' 1; OS Q, Or CUPERTINO
0 ° f(IIJ, ssG/
0 a Sani[ary No.
s i oP- 1968
a , Date _ 19 _ trait No. -57-Z G/S, A
0
4 w Application is hereby made for a.pe:mint to
i m a r .,Tvto3,TYP"'� j1.. !L' Z, Building
ito be occupied only as� �
0 o Plans, Specifications and Plot-Plan file her Ith. A&I Ck Fee
"; Estimated Value of Improvements,$ . Fee S Aar 4 TO
iJ 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
0 Cupertino will be complied with. '
3 m(�Owger G L� Address /
W a!/ BY Address i570/✓��ff �ah %s�
-U Phon �- Sd Approved WILLIAM D. BENEVICI-I
'I State License BUILDING INSPECTOR 00�