S0496 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING.-ELECTRICAL r TT NO,
RUI OF C DIVISION APPI,IOATION/PERMIT PLUMBING-MECHANICAL 0496
BUILDING PROJECT IDF,N'I'IF'ICAI ION-
- SANITARY NO. AI'I'LICATION SUBMITTAL DATE
BUILDINGADDRE55:
O NAME PHONE: IJ C RA 'ORS E: LIC NO:
NIC CO8'IROI.N
gal 23
•i ARCHITECT/ENG N ER: G LIC O: ADDRESS: 4± 1 J - ❑
CONTACT: PHONE: BUILDING PERMIT INFO
.. ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT , PLUMB MUCH
LIC17NSED CONTRACTo R'S DECLARATION QTY. ELECTRIC PERMIT "FEE
I hereby affirm that 1 am d llcensnuclei provision,,of Chapter 9(co arachriag J06 DESCRIPTION
WOZ with Section 7")of Division 3 ofthe Business and Professions Code.and my license is RESIDENTIAL:
¢O PERMIT ISSUANCE
F�� in full force eReci � -' CSFDWL [I KITCHEN RF.h10DGL
aVU Limn. Cls U Lu, _ APPLIANCES-RESIDENTIAL ❑ADDITION D PLUMBING RF-PIPE
<ZU Date Co.lmclnr
�,¢y GMUI,TIUNIT CSTRUCfURAI.
ARCHITECTS UECL A ION PANELS
Z O rn Z 1 understand my plans shall he used as public reenrds MODIFICATIONO Z 14.. UP'T0200 AMTS
C IN'FIiR10R 7 CHIMNEY REPAIR
�Nt:W Licensed Professional 201-100AMPS IMPROVEMENT DSWIMMING POOLS
ce �'; OWNER-BUILDER DECLARATION OVER 1000 AMPS D BATH REMODEUBEPAIR ODEMOLHTON
�J C C Q I hereby affair that i am exempt from the Contractors License Law for the
�yj 3�F following renmo.(Section 9031.5.Business and Pr..fmount
.inns Cade.Any city or cy SIGNS ELECTRICAL
[-I OTHER
y which requires a permit to construct,alar,improve,demolish,or repair any someone
�y�;