25891 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINOtfru.'IBNG-EI:ECTRICAI. PERMIT NO.
APPLICATION/PERMIT PLUMBING-MECHANICAL 25891
BUILDING DIVISION BUILDING PROJECT IIIF.NTIFICATION
BUILDING ADDRESS. SANITARY NO. APPLICATION SUBMITTAL DATE
UNIT# LOTH
O=r: NONE: C RACfOR'S�NAAME:^I� LIC NO:
(� 1 �.1 N/C CONORGLer
wie RCHI'1'IiCI'/F:NGIN[ER: LIC NO: ADDRES // pp
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CONTACT: PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
PERMIT ISSUANCE ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
qCZ Ihambyaf onhat lam licensed undcrprevisioasofa.prr9(commencing with IOB DMCRIPr N
�u00 Sllforetand efDlvisinn3of the Business and Professions Cade,and my license is In PANELS
pdUF full farce and effect.
FZUJ License Class Lie.# LJPT02WAMN
tidy Die Comrucmr 201.1000 AMPS
Z Or"ir E ARCHI3ECI"S DECLARATION OVER IOW AMPS SQ.IT.FLOOR AREA. $/SQ.19.
OZ_Cy 1 understand my plans shall be used as public records.
SIGNS ELECTRICAL
Q S� Licensed Professional.
a ocOWNER-BUILDER DECLARATION SPECIALCIRCUIT/MISC.
x OI 1 hereby affinn that I nm exempt from the Comment's License Law for the
W'3tor following reason(Section 7031.5,Business and Professions Cade:Any city or county TEMP.METER OR POLE INST.
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