24617 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OFCUPERTINO N I D;NG-ELELTRI AL PERMIT NO.
APPLICATION/PERMIT PING PRODR NO CMECHANICAL
DENTFIC24617 4 6 1 7
BUILDING DIVISION BUILDING vROJF.(TI'IDENTIFICATION L YV�
BUILDING ADDDD1R/ESS: SANITARY NO. APPLICATION SUBMITTAL DATE
UNIT N LOT p
CONTR C O 'S NAME:
is C CONTROL IN
ARCIIITECI'/ENGINEEN: LIC NO: AD ES : ^. ❑
CONT
PHONE, QTY.
QTY. ELECTRIC PERMIT EE BUILDING PERMIT INFO
'//
/�-6 f PERMIT ISSUANCE - BLDG ELECT PLUMB MECII
❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL LOB DESCRIPTION pyZ IM1crcby afEnn Nmlam licensed sendsrprovisi les ,Cade 9(nnnmen<ing with /1
woo Scai.n 7000)of 'stria 3 it the Business an fessi...Castle and my,license is in PANELS
yU� full force an eff'd � /
FZW Liccnvc Lic.p (/fC UP TO 20o AMPS
.bDam Coalman, 201-1000 AMPS
—Moo
S RCII11'IiCTS DECL SQ.IT.FLOOR AREA $/SQ.FT.
C)zr3p 1 u rsandmyp ex,fedlbeesial spublierecmds. OVER I(Np AMPS
SIGNS ELECTRICAL
Y , Licensed Professional
,:,a'Q OWNER-BUILDRR DECfARATION SPECIAL CIRCUITIMISC.
kOaU 1 hereby strum that 1 am exempt from the Coul.tor'm License Law for the
1+13.1- following region.(Section 703 LS,Busiress and Professions Code:Any city or county TEMP.METER OR POLE INST.
F'a an;