99100055 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PEKM
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL. 00001
DUILDINGPROJECTIDNMJ
IPICATION
AUDR&SS SANITARY NO. APPLICATION SUBMITTAL DATE
NEIr9N �sA q! A PHONE: CONTRACTOR'S NAM
'L✓/ 'N,P )'2� NIC CONTROL#
RCHITI:CT/li EER: LIC NO: A D C Yo v �� ❑
cONTpC PHONE: U BU
ILUING PEHMI'1'INFO
5 ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
'17JCENS D CONTRACTORS DECLARATION ELECTRIC PERMIT FEE
1 hereby action that I an licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
�04Z with Section Man ofUivlslon 3 ofthe arsine..and Professions Code, mlicense is RESIDENTIAL:
RIOp y / EMIT ISSUANCE
1-ly_ in roll tome aide 0 ❑SPDWL ❑KITCHEN REMODEL
azW LicenseC ss Lo.# APPLIANCES-RESIDENTIAL ❑ADDITION [I PLUMBING RE-PIPE
aca i Date enthrone L-
(..5m ARCHITECTS DECLARATION PANELS ❑MUI.TI-UNIT ❑STRUCTURAL
CZ y1 Z I undersmnd my plans shall be used ns public records MODIFICATION
:1UPT02MAMPS [I INTERIOR ❑CHIMNEY REPAIR
F LR W Licensed Prefessi...I 201-I000AMPS IMP EMENT El SWIMMING POOLS
OWNER-BUILDER DECLARATION OVER TWO AMPS ❑B RI3MODEUREPAIR ❑DEMOLITION
y tY Q I hereby Mo.that I.m exempt from the Contractor's License Law for the
x O a V following reason.(Section 2031.5,Business and Profession Cale:Any city or countyR
SIGNS ELECTRICAL. OI HER — �-Yq1
3 4.H which requires a permit to construct,alter,improve,demolish,or repair any structure a+`I
1" .yo;
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PEKM
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL. 00001
DUILDINGPROJECTIDNMJ
IPICATION
AUDR&SS SANITARY NO. APPLICATION SUBMITTAL DATE
NEIr9N �sA q! A PHONE: CONTRACTOR'S NAM
'L✓/ 'N,P )'2� NIC CONTROL#
RCHITI:CT/li EER: LIC NO: A D C Yo v �� ❑
cONTpC PHONE: U BU
ILUING PEHMI'1'INFO
5 ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
'17JCENS D CONTRACTORS DECLARATION ELECTRIC PERMIT FEE
1 hereby action that I an licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
�04Z with Section Man ofUivlslon 3 ofthe arsine..and Professions Code, mlicense is RESIDENTIAL:
RIOp y / EMIT ISSUANCE
1-ly_ in roll tome aide 0 ❑SPDWL ❑KITCHEN REMODEL
azW LicenseC ss Lo.# APPLIANCES-RESIDENTIAL ❑ADDITION [I PLUMBING RE-PIPE
aca i Date enthrone L-
(..5m ARCHITECTS DECLARATION PANELS ❑MUI.TI-UNIT ❑STRUCTURAL
CZ y1 Z I undersmnd my plans shall be used ns public records MODIFICATION
:1UPT02MAMPS [I INTERIOR ❑CHIMNEY REPAIR
F LR W Licensed Prefessi...I 201-I000AMPS IMP EMENT El SWIMMING POOLS
OWNER-BUILDER DECLARATION OVER TWO AMPS ❑B RI3MODEUREPAIR ❑DEMOLITION
y tY Q I hereby Mo.that I.m exempt from the Contractor's License Law for the
x O a V following reason.(Section 2031.5,Business and Profession Cale:Any city or countyR
SIGNS ELECTRICAL. OI HER — �-Yq1
3 4.H which requires a permit to construct,alter,improve,demolish,or repair any structure a+`I
1" .yo;