51167 (3)2/742 I loA m7Qut LOT NO.
NO. STREET
APPLICATION FOR BUILDING PERMIT
"0"1017 CUPERTINO
II 1 Sanitary No.
Date X- law 9 _ Q iV9, Permit No. // G
/422
Application is hereby made for a permit to _
a r I T Y sntoy,Typl
`PPRTIAIO /� Building
to be occupied only as J kO Ir PAP / in accordance with
Plans, Specifications and Plot -Plan filed herevinh. PI Ck Fee
Estimated Value of Improvements, $ 300 0 Fee $ / 4-'t�
It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
all other laws applicable to the construction, location, and use of buildings within the City of
Cupertino will be complied with.
Owner f�i 4�IIJBt Address Z:iL Z. re/&A P I,g'US
By%if as /040o Address'% e0oov r
Phone ✓t% %S O ,Approved
State License 0 • O� BUILDING IN R