30344APPLICANTTO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEWONLY
CITY OF CUPERTINO .m BUILDING - ELI?CI'RICAL /
BUILDING DIVISION - APPLICATION/PERMIT PLUMBING - MECHANICAL
BUILDING PRojECr HH:NTUDCATION
PERM] PNO. 30344 /N
33
-
ILDINGADDRESS: -
SANI'T'ARY NO,
APPLICATION SUBMITTALDATE
" I
TI �IYI 25 WLeT'SZ
ALI
CMrRAfOR'g NAME: LIC NO:
41
N/C
❑
CONTROLM
-4
'ARCHITECTIENGINEER: LIC NO: „
1.
ADDRESS:
CONTACT': PHONE:
-
❑ Consultant Fees Paid by Applicant (Initial)
BUILDINGPERMIT INFO -
BLDG ELECT PLUMB MECH
❑ ❑
LICENSED CONT'RACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter,9 (commencing
L with Section 7(M10) of Division 3 of The Busincss and V'ofiriiuns Gale; and a,, 'cans, is
in full funcund'Haer. -
j License Class Lic. »s�
Dare Cnnhaan
QTY
- ELECTRIC PERMIT
FEE
JOB DESCRIPTION
RESIDENTIAL: -"
❑SI'DWL O KITCHEN REMODEL.
'[]ADDITION ❑PLDMEING RGPIPE
El MULTI-UNIT ❑STRUCTURAL -
MODIFICATION
i]INTERIGR �f CHIMNEY REPAIR
IMPROVEMENT
i] BATH REM L
❑OTHER
I •
PHRMITISSIJANCH
APPLIANCES - RESIDENTIAL DENTIA.
1. ARCHITECCS DECLARATION
C I understand my plans shall he used as public records
PANELS
UP 10 AMPS
tl Licensed Pnofeasbmal" Y
- ' OWN17R.B1JILDF.R DF,CIARAI'ION
Q 1 hereby affirm that I am exempt from the Commeam's License Law fur the
following reason, (Section 7031.5, Business and Pmfessinns Code: Any city or county
which requites a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance. also requires the applicant for such permit to file a signed statement
E thin he is licensed pursuant to the provisions of the Contractor's License Low (Chapter 9
(commencing with Section 7000) of Division 3 of the Nosiness and P..fia, a, Coda) or
q that he is con nqu Iherefmm and the basis for the alleged cie ntua m Any violinium of
nSection 7031.5 by any applicant for u pennil suhjeds the applicant m a civil Iaenahy of
not more than five hundred dollars (S50D).s
❑ I, as owner of the propeny,mmy employees wins wegcs as their sole cumpenmtion,
will do the work, and the structure is not intended of offered for sale j