24471 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO Bun.nlrvc-ELLcrxlau. PE:RMrr No.
APPLICATION/PERMIT PLUMBING CT-MECHANICAL
24471 n n 7 a�
BUILDING DIVISION BUILDING PROJECT 11/&NTIFICATIOH L L� [� 1
BUILDING ADDRESS: 111lf`� SANITARY NO. A1PIY,ICAwTI�ON SUByMrFfAL DATE
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Oy'yy1iNS NAME: PHONE: O RACTORS N E: O: � _fir✓
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NIC CON'IROLI
•ARCHI'1'IiCT/EN 'R: LIC NO: R+'S: \-F'C,I
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CONTACT: PHONE: QTY. ELECTRIC PERMMIT']'F FEE BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
PERMIT ISSUANCE ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
O5Z I hereby affirm that l am licensed under provisimsofCTapmr 9(commencing with I JOB DESCRIPTION
1+100 Scene.7000)of Division 3 of the Buslnn'sand Professions Codc,and On,license is in PANELS
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