28396 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINOBUILDING-ELECTRICAL PCRMITNO, w a� w
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING MECHANICAL LyCj1 �1J
BUILIIING PROJECT IDENTIFICATION
BUILDING ADDRESS: '/ `l/ l /)� ,(pL R 7 SANITARY NO. APPLICATIONSUBMI TALDATE
V OI f 2 UNIT'#Ta � s/ 4 1 LOT#
De Itlt NA i aN. � N6C AUTO NAMLI NO.
ori'le4 `l0O1L /1 biz N/C V CONfROLp
IITECTA GINE : LIC RKSS:q ❑
QK wcN DJIik �O C' J4 (tta'ri�pl/
CONT ,PONE: BUILDING PERMIT INFO
Sc C QTY. ELECTRIC PERMIT FEE
/ BLgG ELECT PLUMB MECH
J Jd", 2� -A 72
PERMIT ISSUANCE TL/( 1:1 11 ID
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION
Metz I hereby affirm that l am licensed underprovisiomofChapter9(commencing with
LL failSevtin
ce and effeect.Iq on f Il
Sose Business and Profejjssions
Code,and my license is in PANELS I^ / l
<z License Class LIc.N • Z UPT020AMP5 V v s-'L!/
f=y
Dam
Contractor (L(y]� 20I-1008 AMPS
Z Ovyi�' CHI'1'ECTS UEC RATIO v OVER IM0 AMPS SQ.FI'.FLOOR AREA EISQ,FT.
OZ—I] Iunderstand.,,[.a shall hamedas Public..Ms.
MW SIGNS ELECTRICAL
Licensed Professional
6OWNER-BUILDI?