99080053 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY U
CITY JF CUPERTINO BUILDING-ELecrxICAL ER{
"BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL SOOOI1
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NDINC PROJKCEIDHN'1'IFICATION
SAMTARY NO. APPhIC�A
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OWNER'S NAM1h HONE: CONTRA 'S NAME: LIC NO: NIC CONCROLN
CPIITIiCC/IiNGINEF.R: LIC NO, ADDRESS: EJ
CONTACE PHONE. BUILDING PERMIT INFO
1li O ., 1� ❑ Consultant Fecs Paid by Applicant(Initial) BLDG E7IT PLUMB MliCll
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LICENSED CONTRACTOR'S DECLARATION QTY. f:LECTRIC PERMIT FEE JOE DESCRIPTION
I henti,affirm Ihat I ren licensed under pmvisi.ns of Chapter 9(cmmasoncing
claZ with satins 9lXNp.I DivisionJol lbc Business and l'ndcvsious Carla and nryliccnuis RESIDENTIAL'
WOO 1 PERMIT ISSUANCE �] (`
F p fullm cmrl off,
\.L/ l_ �SI'DWI. ❑KI'1GIlEN REMODEL.
GU U License .1.s'�a Lia N ``^ �"'�'
v�i6i Dam Coneacmr AT\IiC APPLIANCEti-RI?SIDF.NTInI. []ADDITION El PLUMBING BE PIPE
ARCHITECT'S DF.CIARAI'[ON PANELS ❑MULTI-UNIT ❑STRUCTURAL
"N Z I oaacomnd my plans shall he used as public records MODIFICATIONZpvs.. UPT0200AMPS ❑INTPRIOR [I CHIMNEY REPAIR
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