S 2613 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO TRRLDING-ELECTRICAL, PERMI'I'NO.
BUILDING DIVISION APPLICATIONIPERMIT PIAIMn NG-MECHANICAL. S 2 613
1 IIUII.DING PRO.IECI'IDI!N'1'LFLCATION 1
BUILDING ADDRESS: SAN["PARY NO APPLICATION SUBMITTAL DAJ E
�7 I` 6 2 GN . - -Z `77
OW ER:S M� PH(INE: CONTRACTOR'S N ME; LIC (l: NIC CONTROIL#
'A ITEC'I/ENGINEL'R: LIC NO: 1 DRE
'l SS: L ❑ ,
I
cONI'ALT: PHONE: BUILDING PERMIT INFO
D/� _ E] Consultant Fees Paid by Applicant(Initial) m,DG�- ELECT, PLUMB MEC
LICRATION QTY ELECTRIC PERMIT FEE
I hcrehy difnd that I um licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
OK'Z with Seaimt 9pfq)af Uivlsion3afthe ltusinessw fessinm Cale,nail mylicenm is RESIDENTIAL"
0p infall torte and eliec PF.HMI'I'ISSIIANCii
��r 0 3TI ❑SFDWL " ❑PLUMIiNRHMODIiI.
UV Littns .I. hiaN APPLIANCES-RESIDLNTIAL ❑ADDITION ❑PLUMBING RC-PIPIT
vi-iQa Wm Cmmm�o
F❑m AHCHITE(TS U[C RA'f UN PANELS ❑MULTI-UNIT []STRUCTURAL
Z Orn Z 1 understand my plans shall he used as public records - MODIFICATION
OZ_O UP TO 200 AMPS ❑INTERIOR [:1 CH IMN EY REPAIR
F"W Liven"l Professional 201-IIXq AMPS IMPROVE ENT ❑SWIMMING POOLS
z,I� 1lWNER-BUILDGR DECLARATION OVER 11000AMPS 62VATH RHMODELREPAIR ❑DEMOLITION
Q 1 hereby affuthat I am exempt from the Conwcmr's License Law for The�x°( station
U fallowing reason.(Section 7031.5,Business and Profession+GELECTRICAL
Any city or county SIGNS ELECTRICA ❑OTHER
al'3 W y which rclaims a permit to consnuel,allim improve,demolish,or repair any structure
�0J prior to its issmamcc.at so vc ir..Je npplirem for amhperntiUolile a signed stammcnt SPECIAL CIRCIII'IIMISC.
6 that be is l iaenwd pu...emus The proviaoncafth,ComneTor,License latw(Chaple,)
WE5 (comnrrcing with S.W.700ajof Division defile Business and Pmfcuiom Cvdelor TEME MRU3R OR POLE INSII COMMERCIAL:
IL Xo rG Tom he is esempl therefven and the ha,k for the alleged exemption.Any minded of El NEW ELDG/ADDITION ❑DEMOLITION
td li Seelion7031.5 by nfly upplicam for a permit subjects the at,ldicannn a MI penalty if POWER DEVICES ❑ ,NAM(' ❑FOOD SERVICE
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