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CI TY OF CUPERTINO • BUILDING-ELECTRICAL,' Ii I'I'NO.BUILDINui DIVISION APPLICATIONIPERBIIT PLUMBING.-MECHANICAL V 2050
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BUILDING PROJF,C'T IDENTIFICATION
BUTLDINGADDRESS: Q.f SANITARY NO. APPLICATION SUBMITTAL DATE
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OWNERS NAME: 111IONII: CONTRACTOR S NAME: LIC NO'.
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ARCHITECUENGINEER: LIC NO: ADDRESS: *Vt ❑
CONTACT: PHONE: - BUILDING PERMITINFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT' PLUMB MliCH
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LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
CIZZI hereby affirm that 1 am licensed under provisions of Chapter 9(commencing JOB DLSCRIPTION
wo, with Section 7000)of Division 3 ofthe Business and Professions Cale.and my license is
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CWF in full farce and eke . layg I� _ ❑til'DWI. f� ❑KITCHEN REMODEL
QU[) Latera Class Lica APPLIANCES-RIiSIDF.N'I'IAh ❑ADDITION } ❑PLUMBINGRIiPIPE
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