29413APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING - ELECTRICAL
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING. MECHANICAL
PERMIT NO.
29413
'
BUILDING PROJECT IDENTIFICATION
BUILDINGADDRESS:
0,32 C£
SANITARY NO.
APPLICATION SUBMITTAL DATE
2)
f
OWNBB'S NAM?: PHONE:
Q2 G /R'A
COM A R'S NAME: LIC NO/�
H7 C/awe I
N/C
CO 'IROLp
❑
ARC] 11'1170'/ENGINEF.R: .IC NO:
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A BSS: S'G 1 ✓
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❑ Consultant Fres Paid by Applicant (Initial)
BUILDING PERMIT INFO
BLDG ELECT PLUMB MF.CH ,
❑ X ❑
LICENSED CONTRACTOR'S DECLARATION
1 hereby a1Brm that l am licensed under prnvisions of Chapter 9 (commencing
with Section 7000) Of Division 3 ofthe Business and Professions Code. and my license is
in full force and effect.
License Chsa Lip. p
Dme - Camactar
QTY ELECTRIC PERMIT FEE
Kz
1-100—
1" W
V UL
F�W
I--gt��y
0 0 4 I
JOB DESCRIPTION
RESIDENTIAL:
❑SFDWL ❑KITCHEN REMODEL
❑ADDITION ❑PLUMBING RF. -PIPE
❑MULTIUNIT ❑STRUCTURAL
MODIFICATION
PERMIT ISSUANCE
APPLIANCES—RESIDENTIAL
ARCHITECTS DECLARATION
understand my plans shall be used us public records
PANELS
Z q
r+�.,{y
LN a -J
6 G
F O ~
sssss ��rsny�ys�
LicenxeJ Prnlvvaianal
ON
Oe, I ma BUILDER naiCe Contractors
1 hereby affirm on 1 1S exempt from the Cosigns C's License Law for the
followingaresMason (Section ]onstru Business and Professions Cade: Any city nr roomy
which its requires s a permit to comswcL alcor, improve, demolish. Or repair any saunarc
that hor Osssiensedprsu requires the powisilnsoftheant for such Compactor toicensle ae ned Law
that he is licensed pursuant to the pmvisiom ofthe Contractors License lsw (Chvpter9
UP TO 200 AMPS
❑ INTERIOR CHIMNEY REPAIR
IMPROVEMENT
❑ BATH REMODEL/REPAIR O DEMOLITION
❑OTHER
2111-IOIXIAMPS
OVER ["AMPS
SIGNS ELECTRICAL
SPECIAL CIRCUIT/MISC.
TEMP METER OR POLE INSL
COMMERCIAL,
❑ NEW BLDG/ADDITION ❑ DEMOLITION
OTENANT ❑ FOOD SERVICE
IMPROVEMENT
❑ OTHER
IGpO
a q = C
i4C1 4,
j,
O01,
(wm...... gwith Secdon 7f00)of Uivision3of'he Baairrcss and RofewionsCMe)or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for o Permit uhjects the applicant (I a civil penalty of
and .,.,a 'ban five hundred dollars ($500)'
as owner ofthe property, or my employees with wages as their sole compcnsntm,
will do the work, and Ne stactre is Out incended,umficned far sale (Sec. ]144, Business
POWER DEVICES
SWIMMING POOLELEMRIC
W
4i 3 r
and Professions Code: "a Contractor's Licence Law does not apply In an owner of
properly who hands or improves dwea n, and who does such work himself ar through
his own employees, provided shut shah improvements are not intended nr offered for
OUTLETS—SWITCHES _I IX'I'URES
NEW RESIDENTIAL HI.HC'I'll SQ PT.
SQ4 .FLOOR AREA
AR 1
$/SQ. FT.
sale. If, however thebuilding orimprovenann is sold within one year ofcompletion, the
ner.bmlder will have the burden of proving that he did not build or improve far put.
Piece Of sale.).
❑ 1, s owner of the piopeny, am exclusively contracting wird littnxd contractors to
construct the protect (Sec. 7W, Business and Professions Cade:) The Contractors Li.
TOTAL:
cane law drops not apply to an owner ofpropeny who builds or improves there
Qon,and Try, PLUMBING PERMIT PEE
g 19 96
who contracts forsuch ¢with lid h
projeea conlmctodx)censepursuant to the Contractors
License Low.
1 am exempt,, Mer Sec. B & P C for this mason
PERMIT ISSUANCE
� vUU
Ur (.Ur�rtlIIY )
ALTER - DRAIN & NEW - WATER (EA)
�❑
Owner Dale
VALUATION
WORKER'S COMPENSATION DI?