31315 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMITNO.
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL /
BUILDING PROJECT IDENTIFICATION
BUILDINGADDRESS SANITARY NO. APPLICATION SUBMITTAL DATE
a 3 3
OW ILA PHONE: CON O 'S pA6[; LI O N/C CON]ROE.
ARCHITECT/ENGINEER: ILl LIC NO: A DR IH`�7 ❑
FiGt.�,o c-T.
CONTACT:- - PHONE: BUILDING PERMIT INFO
` ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB ECH
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
1 hereby afar that I am licensed under provisions of Chamw 9(mmmtcaeing JOB DESCRIPTION
DOZ with Section or Divlsion3ofthe Business and Professions Code,and my license is RESIDENTIAL: -
F in full force end cot PERMIT ISSUANCE
aUU License Lic4 ❑SFDWL ❑KITCHEN REMODEL
F-Zln Da¢ �� Continuum APPLIANCES-RESIDENTIAL ❑ADDITION El PLUMBING RE-PIPE
m Q 6 �n ARCHITECFS DECLARATION ❑MUCTLUNIT ❑STRUCTURAL
f+D an PANELS
Z O rn Z I understand my plans shall be asides public records, - - MODIFICATION
OZ—O UP TO 200 AMPS
El INTERIOR El CHIMNEY REPAIR
Licensed Professional 201.1000AMPS IMPROVEMENT
OWNERBUILDERDECLARATION OVER IOW AMPS El BATH REM D IJREPAIR ❑DIiMOLITIO
y C W Q 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
X L U following rea.cnrt(Section 7031 5,Business and Professions Code:Any city or county SIGNS ELECTRICAL ❑OTHER
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ai+ y which r coins a permit io construct. he,improve,demolish,or repair any swcturc
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