6810�T ('
LOT
1,
j� -APPLI A ION'F It BUILDING PERMIT
feN1 }MAR, LS' 1 Q�r CUPERTINO / ry
~
Date (D d
' -� 1 Peunit No.
A))jiEwn ' rer a it to
a story, Type uilding
at
to be occupi dvnly
in accordance with
I'stimated/y jlue of
It is hereby agr
:dl other laws' ap li++'
Cupertino vVI be,cq,
Specifications and Pr/--PIat� Wed herewith. 00
: en ents, $ �O O Pee $
e requirements of the Cupertino Building and Zoning Ordinances and
the construction, location, and use of buildings within the City of
AGENT
Address
Address
Approve
BIDLDING INSPECTOR ✓
. I
��� RECORD OF INSPECTION APPROVALS
EO11N6A
FRAME
DATE
LATH and PLASTER %
INSPECTOR
DA� INSPECTOR
FINAL BLDG. �p/ �
DATE INSPECTOR
1
FINAL ELEC. I
FINAL PLBG.
FINAL GAS
DATE
DATR
I-
DATE o
INSPECTOR
INSPECTOR
INSPECTOR -
-'the'undersigned-'do. hereby certify tliat I am' _
the oimer 'an d',, currant 'of the "single '£amily'direlling at
/D- D..-... £_ which `I am' m king
application to d
work as,a home owner.
also -certit that 'I vrill 'no hire any non_liccnsed` '
or contractor, but will de this;vrork myself,
i
TnEPi.0NE i,NNu3Er SIGNATURE "