30365 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. O
- BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING PROJECT IDENTIFICATION
DINGADDRESS: SANITARY NO. LICA'I'ION SUBMI ITAL DATE
7
EELS NAME: PHONE: ON] ORS ME: / LIC NO:
I O. ,�An to zags NIC CONTROL
\RCH ITECT/ENGINEER: LIC NO: DDRESS: �i� ❑
S
CONTACT: ' PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) - BLDG ELECT_ PI IstB MECH
❑ ❑ ❑
LICENSED CONTRACTOR S DECLARATION QTY ELECTRIC PERMIT FEE
I hereby affirm that 1 am licensed under p mRI
s of Chapter 9(comencing JOB DESCPTION
Fob
Dwifh5 i ]alit) fD n3 fate Busie aJvnf sdrnC 1 and mylhnse ie RESIDENTIAL:
in full fmat,and e0'ea. PERMITISSUANCE
y I+)F- ❑SFDWI. EJ KITCHEN REMODELaVU License Claa Lie.#
oo APPLIANCES—RESIDENTIAL ❑ADDITION C)PLUMBING RE-PIPE
G i Date Contractor
Fir/)
ARCHITECTS DECLARATION ❑MULTI-UNIT ❑STRUCTURAL
PANF.IS
Zp4Z Irndersmnd my plans shell be used public records MODIFICATION
OZ—C UPT02IX1AMPS ❑INTERIOR ❑CHIMNEY REPAIR '
[F�F'W License)Professional - 201-Rd0AMPS IMPROVEMENT
f; OWNER-BUILDER DECLARATION OVER I(N1)AMPS El BATH RF,MODEVREPAIR (]DEMOLITION
C d a 1 hereby amen mai I am exempt Item the Contractoris License Law for the
E:C LL trU - following reams.(Section]031.5,Business and Professions Code:Any city ou"nortY SIGNS IiLF.CTRICAI. ❑OTHER
y which tryeaires a#emit to construct,alter,improve,demolish,or repair any Solarium";