29676 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING.ELECTRICAL PERMIT N0. Ln 9 6 7 6
BUILDING DIVISION APPLICATION/PERMIT PLUMBING.MECHANICAL
BUILDING.PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
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O F,R'fS/N'AM : �`N�asA PHONE: CONTRACTvR:S NA, E: ` I.IC NO.
X"Q (.J P1P" A _ lt-�1 S 1v�6f NIC CONTROL#
•ARCHITECT/ENGMEER: '•, LIC NOT^ ADDRESS: - ❑ "
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CONTACT: PHONE: ' BUILDING PERMIT INFO
5o e X367-6 o i 1:1 Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MUCH
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LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
I hereby anirm that I am licensed under foreman,of Chapter 9(commencing JOB DESCRIPTION
WON with Section 700( of Division 3 ofthe Business and Professions Code,and license is
SIO )�5T '/ y PERM1IIT ISSUANCE RESIDENTIAL:
W-E' Lid. force and effGt�^b a 1cl ) ❑SFDWL ❑KITCHEN REMODEL
aVU License Class Lic.# �l
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APPLIANCES-RESIDEN9'IAL C3 ADDITION El PLUMBING RF-PIPE
TAn — WHITECTS
D cry
DECI, ATIO ❑MULTI-UNIT. ❑STRUCTURAL
Z O y Z 1 understand my plons.vhall be used us pubANIiLS public records MODIFICATION
Oil 10200 AMPS CINTERIOR El CHIMNEY REPAIR
F4t:W Licensed Professional 20I-I000AMPS IMPROVEMENT
OWNER-BUILDER DECLARATION OVER IOOOAMPS C BATH REMODEL/REPAIR El DEMOLITION
Q I hereby affirm that I am exempt from the Contractors License Law fur the
3 M U following reason.(Section]031.5.Business and Professions Cade:Any city or county SIGNS ELECTRICAL. C OTHER
ILE`rn which requires a permit to construct,alter,improve,demolish,or repair any structure
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