S0098 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITYOICCUPERTINO BUILDING-ELECTRICAL - PERMIT NO.
BUll DING DIVISION APPIACATION/PERMIT Pl.umxlrvc Mb:cxnrvlcnl.
r BUILDING PROJECT IDNNT'Ib'ICATLON
s BUILDING ADDRESS: SAfl1'1'AR ,O. APPLICATION SUBMI'1'IAL DATE.
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OWNSS VE: PHONE: NEOACTN R'S NAML Jr / <2� NIC CON7RCE4F
ARCHITECD/ENGINEER: LIC NO: D Z&
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CONTACT: PHONE: BUILDING PERMIT INFO
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LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE' JOB DESCRIPTION
1 hereby of ner that 1 am licensed under provialons of Chapter 9 from"Zang
WCZ with Satinn]IXMI)of Division lof the llw,iness and PrOfeszinns Code,and my license is RESIDENTIAL'
t PERMIT ISSUANCE
FesW—O in full force and eBept. ❑SFDW'L C1 KITCHEN REMODEL
azu License➢Ws_ LiaM APPLIANCES-RESIDENTIAL OADDIT16N ❑PLUb1BING RI PIPE
y4i Date—g4 e"7T Contmclnr ❑MULTI-UNIT ❑STRUCTURAL
ARCHITECT'S DECLARATION
F nz i understand my pler,,b.11 he used to,mble record, PANELS MODIFICATION
OZ=— UP TO 200AMPS (_1 INTERIOR El CHIMNEY REPAIR
�mF Licensed ProRxsional 201-1000AMNS IMPROVEMENT LJ SWIMMING POOLS
�; OWNER-BUILDER DECLARATION OVER IOW AMPS [_1BATH REMODELIREPAIR DEMOLl'I'[ON
CC C Q 1 hereby affirm that I ant cxu.rpl Bore the Contractors Licenre Law for the
W O following maem.(Section 7031.5,Business and Profc,oum,Code Any city or county SIGNS BLECPRICAI. OTHER
which reactive,a permit to consmmt,ultee intProve,demolish,or repair,any nmewre
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