S 2050 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY ,. (JG.0 ��(�/yti
CI TY OF CUPERTINO • BUILDING-ELECTRICAL,' Ii I'I'NO.BUILDINui DIVISION APPLICATIONIPERBIIT PLUMBING.-MECHANICAL V 2050
_
BUILDING PROJF,C'T IDENTIFICATION
BUTLDINGADDRESS: Q.f SANITARY NO. APPLICATION SUBMITTAL DATE
Co38a �n' w�� <� R SO
j4 ��l
OWNERS NAME: 111IONII: CONTRACTOR S NAME: LIC NO'.
• S lit—
NIC CONTROL# `
ARCHITECUENGINEER: LIC NO: ADDRESS: *Vt ❑
CONTACT: PHONE: - BUILDING PERMITINFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT' PLUMB MliCH
�2' ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
CIZZI hereby affirm that 1 am licensed under provisions of Chapter 9(commencing JOB DLSCRIPTION
wo, with Section 7000)of Division 3 ofthe Business and Professions Cale.and my license is
W adO PERnfIIISSUANCF. RESIDENTIAL:
CWF in full farce and eke . layg � _ ❑til'DWI. f� ❑KITCHEN REMODEL
QU[) Latera Class Lica APPLIANCES-RIiSIDF.N'I'IAh ❑ADDITION } ❑PLUMBINGRIiPIPE
F W 111 a� Cunoa•sr