B 0603APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING - ELECTRICAL
BUILDING DIVISION APPLICATION/PERMIT PLUMBING. MECHANICAL
r IUILDING PROJECT IDF.NTIF'ICATION
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SANITARY NO.
APPLICATION SUBMIITTTALL�DATE
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CONTRACTOR'S NAME. LIC No /
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❑ Consultant Fees Paid by Applicant (Initial)
LICENSES CONTRACTOICS DECLARATION
I hereby .food that 1 am licensed Under provision Of Chapter 9(cmmnemch,g
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ELECFRIC PERMIT
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FEE
JOB DESCRIPTION
PERMrf ISSUANCE
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wim$eco n70M) amivision 3Dnhe BUaessand Prnrewiaen Cade, and my license is
in l all fumemW effect
SPDWI. ❑KI'I'CI {IiN REMODEL
ppl'LIANCES- RESIDENTIAL
License Cla. Lic.N
Date y t Cnnlmmor
❑ADDITION ❑PLUMBING RIi PIPC
❑MULTI -UNIT ❑STRUCTURAL
MODIFICATION
❑INTERIOR El CHIMNEY REPAIR
IMI'ROVENENT C3 SWIMMING POOLS
ARCHITECT'S DECLARATIO
I trade ratxnd my plans shall be axed as pnhlic records
PANIi1.5
UPI0200AMPS
Licensed Professional
20TI000AMPS
OWNER - BUILDER DECLARATION
I berehy an oat that I am exempt Gant the Contractor's License Law for the
following reason. (Section 7031.5. Business and Pone.wions Code Any city or county
❑ BATH REMODF?