109 � NO. STREET
w zAPPLIeATION FOR BUILDING PERMIT
r O )O`�lcic�� I OP CUPERTINO
0 :1 /F�r V+ Sanitary N
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= LL Date 6_ Permit No.
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o Application is hereby made for a permit
a
i m a�a7�V0Ftor , O _Building
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to be occupied only as
o o in accordance with Plans, S cification Plot-Plan filed herewith. a o
n
Estimated Value of Improvements,S X00 Fee$
Oa
z J It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
J z all other laws applicable to the construction, locatiop, and use of buildings within the City of
O Cupertino will be complied with.
3 �
Owner Address
aBy � -l��/ Address S
F �f�37. Z
a U Phone
Approved
/N State Licens - _ Bu ING INSPECTOR
YJ
RECORD OF INSPECTION APPROVALS
FOUNDATION i
DATE. INSPECTOR
UNDERFLOOR
DATE INSPECTOR
FRAME
DATE INSPECTOR
LATH and PLASTER, I
DAT. INSPECTOR
FINAL BLDG.
DATE INSPECTOR
FINAL ELEC.
DATE INSPECTOR
FINAL PLBG. I
.DATE INSPECTOR
FINAL GAS __I
DATE INSPECTOR