S 3149 —APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL - PE TFNO.
BUILDING DIVISION APPLICATION/PERMITPLUMBING-MECHANICAL 3149
BUILDING'PROJECT IDENTIFICATION
BI JILDINGADDRESS. SANITARY NO. APPLICATION SUBMITTAL DATE
r�H' A PHONE: LICN
1 L N/C CONTROLN
ARCHITECT/ENGIN iER: LIC NO: ADDRESS'. K ❑
CONTACT: PHO BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDr DG ELEC'ly- PL7 MEc
LICENSED CON TRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE LrJ
I hereby affirm that I am licensed under previsions of chapter 9 mmmnen.ing JOB DESCRIPTION
O�Z thSection 9000)of Division 3 of the Business and Profession.Gde,andmyliceaseis
rW00 wt. PERMIT ISSUANCE RESIDENTIAL'
y'W in Iull force and effect
6�U Liecnse Class Lic# a ❑SPDWL ITCHEN REMODEL
APPLIANCES-RES I DENTIAL
y<L Dam '— Contra - []ADDITION El PLUMBING RE-PIPE
Z8,[[--� ARC 'fECTS DGCLARATION PANELS ❑MULTI-UNIT ❑STRUCTURAL.
Z [understand my plans shall be.solos public records MODIFICATION
OZ-- UP TO 200 AMPS
yj L¢ense Probe ssm—no I El INTERIOR ❑CHIMN INO POOLS
C6 , 2111-BNIIIAAM IMPROVEMENT ElSWIMM DEMOLINGPOOLS
OWNER-BUILDER DECLARATION
6 I hereby adirm that 1 nm exempt from the Contractor's License Law force OVER IIIIMIAMPS BATH REMODEIJREPAIR El DEMOLITION
4O0.V followin
g reason.(Section a ABusiness and Professions Coda.Any city or county SIGNS ELECTRICAL ❑OTHER 4 y which rcyulrev a permit m C.nmeanamn,alter,improve,demolish,lir repair any notation
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