26500 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
B n, ; - ..LOCAL PERMITNO.
CITY OF CUPERTINO PLUMBING-MECHANICAL 26500
auILDING DIVISION APPLICATION/PERMIT
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS
SANITARY NO. APPLICATION SUBMITTALDATE
OR Q O/v / 10,Ft e V-4e-- UNITM LOT# z-�/o` —cl
OWNER AME: PHONE: CONTRACTOR'S NAME: LIC NO: _N/C NN/ CIII
E -1a k; sr - � 9
ONTROLN
•ARCHITECT/ENGINEPR: t7 LIC NO: ADDRESS: ❑
CONTACT: PHONE: BUILDING PERMIT INFO
QTY. ELECTRIC PERMIT FEE
BLDG ELECT PLUMB MECH
I PERMIT ISSUANCE �Q� I(Pplk- '(TI ILph/tl
LICENSED CONTRACTORS DECLARATIONQ=z APPLIANCES-RESIDENTIAL JOB DF.SCRI
P400 .I hereby ofrmthati 3 ofth Busised ness and
Professions
Chapter and(commencing with V k 0
�W,E Secfall for. it affect. on 3 of the Business and Professions Code,end my license is in PANELS //-v��,^ V'V Vim. 1 �G
y U full force and effect. UP TO 200 AMPS( D
6z License Clazs Lic.N
vF 6 a Dute CowecD OVER
-HOW IWAMPS
F^~n' ARCHITECTS DECLARATION SQ.FT.FLOOR AREA $/SQ.FT.
2Oya OVER 1000AMPS
O2`- I understand my plans shall be used az public records.
�46�.J`y-�,��,.,II Licensed Professional SIGNS ELECTRICAL
E{�d•Q OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
OaU 1 hereby affirm that 1 am exempt from the Communities License Law for the
W 3 P-o,i following reason.(Section 7031.5,Business and Professions Code:Any city or county TEMP.METER OR POLE INST.
I:Ei Oa.] which requimit m re.a perconstruct,chat.improve,demulish,en repair any ametr e
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