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S 0874 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL. PE$A11T NO. 0874 874 BUILDING DIVISION APPLICATION/PERMIT PING PROG-MECENTIFIC lel BUILDING PROJECT IDENTIFICATION BUILDING ADDRESS: SANITARY NO TLICAIIONSUBMIYIAIADATE 210&q Ht*Jre C,—,r OWNPR'S NAME: PHONE: CONTRACTOR'S NAME: LIC NO: L N e 1 NIQt4 .rN NIC CONTROL# RCHITIEC1'/ENGINEER: I TIC • / ADDRESS: ❑ J d LunJJ CONTACD PHONE: BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELE PLUMB MUCH .J••V/ LICENSED CONTRACTOR'S DECLARATION Q•I•Y, ELECTRIC PERMIT FEE 1 hereby affirm that I am licensed under provisions of Chapter 9(cammenceing JOB DESCRIPTION IQMZ with Section 700x0 of Division 3ofou Business and Professions Cache.and my license is RESIDENTIAL F00 in PERMIT ISSUANCE force and effectAOWL ❑KITCHEN REMODEL IU� License Class Lir.# APPLIANCES-RESIDENTIAL ADDITION El PLUMBING RIYPIPH 4 Data Commmar [[..7m ARCHITECTS DECLARATION PANELS OMULTI-UNIT ❑STRUCTURAL. Z O�7, I understand my plans shall he used®public records MODIFICATION DP 10200 AMPS OZFQQ [IINTERIOROCHIMNEY REPAIR r,�J,.ul Licensed Pm(essianal 2014 TXX)AMPS IMPROVEMENT C]SWIMMING POOLS g g g[�- OWNER-BUILDER DECLARATION OVER HAND 0 AMPS O BATHIMA 9n1 1 REPAIR O DEMOLITION I hceby affirm that I am exempt from the Contractor's License Law for the 06 U following reason.(Section 7031.5,Business uad Professions Code:Any city or county SIGNS ELECTRICAL E OTHER 3 tL which requires v permit to construct,alter,improve,demolish,or repair any sou on- 0:7 prior in in issuance,also requires the applicant for such permit to file a signed statement SPECIAL CIRCUIT/MISC. Z that he is licensed pursuant n the Provisions of the Communes License Law(Chapter 9 ITVYT % GAO (commencing with Section 7")of Division 3 ofthe Business and ProfemionsCcale)ar TBMP.METEHORPOLEINST. / a ea 2' that he is exempt therefrom and the basis I'nr the alleged exemption.Any violation of 61QW BLDG/ADD( El DIiMOi.ITION ^ Section]031.5 by any uppliwm fnrapermit mhjcros the applicant to a civil Penalty of POWER DEVICES `', r s„ not more than five handled dollars($501h. ❑•IMPROf [A/y El 17001)SERVICE � OLa ownerof Ne pmpeny.or my employecawidt wages ns their aolecampensatiun. SWIMMING POOL ELECTRIC IMPROVEMEN'�/IPV will dothe work,and Ne immure is nm intendedornEered formic(.Sec.7014.Easiness OTHER Land Professions Code:The Contractors License law arses not apply to an owner of OUTLETS-SWITCHES-FIXTURIS .. property,who builds or improves thereon,unit who does such work himself or through his own emplayces,provided that such improvements are not intended or offered for NEW RESIDENT]AL ELI?