99120126 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY aUI
CITY OF CUPERTINO BUILDING"ELE6TRICAL PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT I-I,FMBING-MECHANICAL
BUILUrvG,\DDRS: BUILDING I-ROJEC'I'IDEN'I'[FICA']'ION
SANITARY N(l. AI'I'LICATI(IN SUBMITTAL UA'1Ii
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OWNERS NAM!: PHONE CON CI0125 NAyI& LIC NO:
]JCC' Cmc-/ NIC CONT ItOI.a
RCIIU'fiCfrtTNGINfiER: ACNO. -0162. ADyqkfgDRESS: V� a ChJO E3C(IN'nC'I: I'UUNH: VV 6. HUII"DING PERMITINFO
❑ Consullanl Fees Paid by Applicant(Initial) BLM) i.ECl. PLUMY MITCH
❑ ❑ ❑
LICENSED CON'fRACIORS DECLARATION Qty. ELECTRIC PFRMjT I'EE JOB DESCRIMON
1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
DMRFSIDPNTIAL
OrionJ 01 me Heonessend Professions Code,mdmy her.is
WOZ wipbSston]IXN1fDi
PERMIT ISSUANCIi
F full force and effect. ❑SPDWI. ❑KITCI{ER REMODEL
H Z6U1 Dm¢wClasa `'-� Lue.# e—�` APPLIANCES-RESIDEN'I'IAh ❑ADDITION ❑PLUMBING RIi-1'11'1:
'�Qa ARCHITECES DECLARATION ❑MULTI-UNIT ❑5'0D[FI RUC NRA(;
Fvnz Imdersmmdm 1 hll beised as Public records PANCIS MODIFICATION
OZ YPanssa Pu UPTO100AMPS ❑INTERIOR ❑CHIMNEY REPAIR
Lueenocal Prof oonal 201-HX00AMPS IMPROVEMENT [D SWIMMING POOLS
OWNER-BUIhDERDITCIa\RATION OVERHXXIAMPS ❑BATH RHMODEUREPAIR El DEMOLITION
C C Q I hereby affirm that 1 ran exempt m
pt frn the Contractor's License I.aw for the ❑OTHER
XO L U following¢awn.(Section]031.5.Business and Prefessiom Code:Any city or county SIGNS ELECTRICAL
613 6.I- which requires a Permit to cons Wet,alter,improve,demolish,or repair nny erc d .+✓
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