25750 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINODO I'VINIJ-toe., TR A, PERMIT NO,
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 25750
BUII.IIING PROJECT'IDENTIFICATION
BUILDING ADDRHSS: SANITARY NO. APPLICATION SUBMITTAL DATE
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OWNERSnA E: ¢¢ r? 4 PHONE: CONTRACTOR'S NAME: LIC NO:
O L ✓ V L'VF DU NIC CONTROLa
RCHHTiCT/FNGINEER: LICNO: ADDRESS: 11
CONTACT: PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BL G ELECT PLUMB MECII
PERMIT ISSUANCE ❑ ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
ozz Ilarchy affirm Nut l am licensed un&rpmvisiansof Chap¢r9(emomarring with IOtl UESCRIPI'ION
�00 Section 7( Mlof Division 3 ofibe Business and Prufesswas Code.and my hcatem is in PANELS
y'6 full fora and effect. ,s
F7I�-..W License Class Lic.p UPl'02W AMPS PC 9-c— pe W-6
L,6 vat Ila¢ Contractor 201-1000 AMPS
OoNZn ARCHITECTS DECLARATION TION OVER IOW AMPS !/I SQ F1'.IiGOIyQEA TQ FT I undersand my plans shall b<usedatpublic records. -1\ ILIA.' IIL�_ 1L.dl
tnF_1 SIGNS ELECTRICAL
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