25966 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO1�VENU-hChc RICA1' PERMfI'NO.
BUILDING DIVISION
APPLICATION/PERMIT PLUMBING-MECHANICAL n C 9 6 Q
BUILDING PR(1jEC'f IDEN'fIFICA'1']ON
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❑UILDING ADDRESS: OA SANITARY NO, APPLICATION SUBMITTAL DDAT
UNIT if LOT to / )'-25e-7 5
OWNRS NAM.: PHONE: CONTRACT OR'S NAME: 1 LIC NO: `
4 C r NIC CONTROLM
ARCHrrcC`UUGINEER: LICNO: AD US: �r^J ❑ /(` � y�
CONTACT: PHONE: C��fr QTY. ELECTRIC PERMIT ' FEE BUILDING PERMIT INFO
1
BR, ELECT PLUMB ME-CH
C PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
❑yZ I herebyaffilm that l am licensed underprovisiom ofChapler9(commencingwith JOB DESCRIPTION
FOO Section of Division 3 oftne Business and Professions Code,and my license is in PANELS
WW— fallI ecand effect. 1
[W License Class Lic.k UPT62MAMPS C
vf—s<y Dae Contractor—
! = 201-1000 AMPS
,7Z ARC)II'I'ECTS DECLARATION OVER IOIXIAMPS SQ.IT.MOOR AREA $XQ.FT.
O!—O 1 understand my plana shall be used as public records.
N F; SIGNS ELECTRICAL
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Licensed Professional y,•X< OWNER-BUILDER DECLARATION SPECIAL CIRCUEOMISC.
XO W V I hereby affirm that 1 nm exempt from the Contractor's License Law Soothe
ul'31+•vf—i folicaso,reason(Sectinn]03L5,9uaness and profession Code:Any city or county TEMP.METER OR POLE INST.
t:E:NO;