26363 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINOIEI)INO- -EL' PERMITNO.
APPLICATIONIPERMIT PLUMBING-MECHANICAL 26363
BUILDING DIVISION IIUILDING PROTF.CI IDEN'HFICA'I'ION
BUILDING ADDRESS: - SANITARY NO. APPLICATION SUBMITTAL DATE?
20300 Stevens Creek Blvd. UNIT# 125 LOT 4;
OWNERS NAME: PHONE' — ONTyACfOR' NA LIC NO:
,rt,irn Ci., T—Centex Assnei — D Q NU CGNTROI.a
AR(THITCUENGINEER: LIC NO: ADDRESS: ❑
CONTp(7f: .PHONE: Y.R @�,#AF ELECTRIC PERMIT FEE ;BUILDING PERMIT INFO
ti v:Xgr3r'st,v_ : - sBLDG ELECT PLUMB MUCH
PERMIT ISSUANCE ❑ ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
OZZ I hereby affirm that l am licensedunderprovisionsofChapre,9(commendng with JOB DESCRIPTION
�WOC) Section7000)A Division 3ofthe Bminessand Professions Code,and my license is in PANELS
y V F full farce and effect
�pW Licensee and L10.# UP T0200AMPS
may Dem Gmtmror 201-1000 AMPS
ZOh7 ARCHITECTS DECLARATION OVER IOOOAMPS SQ.PI'.FLOOR AREA VSQ.FT.
O Z"O I understand my plans shall be used in public records.
F,rat E W SIGNS ELECTRICAL
Licensed PrnfessionaE
L,KP�'6 OWNER-BUILDER DI?