S 1318 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY -
CITYOFCUPF.RTINO BUILDING-ELECTRICAL - PEtIT NO. 1318
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 1`.7
BUILDING PROJEClIDENTIFICA'1'ION
BUILDING ADDRESS: - SANITARY NO. AI'I'hICA'IION SUBMI'I'IAI.DATE.
v J 50 �1N W,A
OWNERS AME: PHONE: CO OR:St&ME: LIC NO:
+ W I Iwo 1 NIC CONTROLp
/ ARC]11'fI!CI'IRNGINEHR: LIC NO: ,1'It -?0x 31z. S. CSI ED
PHONE, VV BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MIiCH
ED ❑ ❑
IACENSHDCONTRACTOR;S D1;CI.ARA'I'ION Q'ry ELECTRIC PERMIT PBG
I nemhy alum ma]."I licensed under provisions of chapter 9 tcommmnoing 10B DBSCRIPT ON
Oat with Section]INXB of Division3nDhe Business and Podessinns CnJe,ane mY license is R -IDS
WOO PERMIT ISSUANCE
WF infullforce and if a�a� g I ❑SFDWI- KI CHEN REMODEL
U License Clms Lp��� Lica -FM'U
- U APPLIANCES-RESIDENI'In1. ❑ADDITION LoUCTURAF.-PIPE
H W Dem Conwesor ��' ��YRRR
�Oh A CUITECI'S UGCLA lDN PANELS ❑MULTIANIT, ❑S UCI'URAI.
ZOy� InndnamnJ my plan.v shttll h+uoJ vv puhli records MODIFICATION
O Z4O UP'10200 AMPS Ll INTERIOR [I CHIMNEY REPAIR
W Licensed Poneaimed 201-IOINIAMPS IMPROVEMENT E]SWIMMING TOOLS
�y$-I OWNER-BUILDER DECLARATIGN OVER Hall AMPS
El RATE RFAfODFuREPAIR ❑DEMOLITION
W a Q 1 barely affivn that 1 an exempt from Ile Confetti License Luw for @e
1L 06 U following rai (S
son. ection 9031.5.Bu,iness and Profession,Code:Any city m musty SIGNS i?I.ECfRICAL El OTHER
W 3 W y which r,cuire,a permit m connnaeL after.improve,dmnm0dt,or rcpdr any eumch n,
pricerlois.si"a se,dsouNioneubeapplicant forxueh pcon,ofilaii,ydsoner-col SPECIA.CIRCUITIMISC.
�y that he is licensed pursuant o the provisions of the Contractor's License Low(Chapser9
O (commencing with Section]IXNI)of Division l of the liminess and Professions Code)Or TEMP.MCI'ER OR POLE INS'C COMMERCIAL:
6 Sx o a shat he i.exempt Ihemfrom addle linin for the alleged exemption.Any violation of NEW BLDG/ADDITION ❑DEMOLITION
Section 7031 S by any aPllaunt for a permit objects she applicant In a civil penalty of POWER DEVICES
ofmo,a than five hundred dollars l SSOE). [-I TENANT ❑FOOD SERVICE,
IMI' 13MF.NT
4' 1 fdcp p nY - Y employee, 'tl bcs a: :