2011_ 4
LOT NO.
Q D AP PLIC 1 OR BUILDING PERMIT
o ° , Q 9 OF CUPERTINO .
3 a Sanitary No..
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Dat eq y $q6_ �erm_it�LNo._ OII
`o pplication is heOF erre�UbbJy made a::99permit tct t� �Yi
i W a _ story, Type Building
to be occupied only as
2. in accordance with Plans, Specifications and Plot-Plaafifled h vtth.
t 3 Estimated Value of Improvements, $� �� Fee $_�oT
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, location, and use of buildings within the City of
o Cupertino wll complied with.
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_ m Owner— ��/C+.CJ uJ H"C—r) Address /9� H
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By / S` 'C, f5 7 Cd /0(-'C- Address s3 S y Ci`
u (� - � 7 lc .i 7
Phone - Approve -2e
State Licens �J'_ -- ` BUILDING INSPECTOR
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