06040048i
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Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
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PERMIT #
OWNER'S NAME: JA6Lr4 L-LxnpS
PHONE #
BUSINESS NAME
GENERAL CONTRACTOR
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FAX #
I am not using any subcontractors:
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Signature Date
Please check applicable subcontractors and complete the following information
Owner/Contractor Signature
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature
Date
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CITY OF CUPERTINO
"HEMP POWER
CITY OF
PERMIT APPLICATION FORM
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Qty. if
Applicable Fee ID
Fee Descrintion
Fee Gmun
BTEMP
Temporary Power
APN #
Date:
Building Address:
ELECTRICAL
BUSLIC
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Owner's Name:
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Phone #:
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Contractor: Phone:
Liens #:
Contact:
Phone:
Cu ertino Business License #:
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Building Permit Info:
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Job Description:
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Cost of Project: Sod a
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Qty. if
Applicable Fee ID
Fee Descrintion
Fee Gmun
BTEMP
Temporary Power
ELECTRICAL
/ EPERMITFEE
Elect. Permit Issuance
ELECTRICAL
BUSLIC
Business License
BUILDING
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