S 0666 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY -
CITY CUP BUILDING.ELECTRICAL
BUILDING DIVISION APPLICATION/PERMIT LUMBING-MECHANICAL I rI3l`�J S
+Ir NO 0666
BUILDING AD DRESS 1t( f;xuaINC PROJECT IDENTIFICATION SANITARY NO AYPIJCA110N SUBMITTAL
DAI_
00,5.2 - m/gaikW19
Q'v�.41
(OWNER' A GU �7� /q,�p Cg I�Sh/Ir)1d 1. ���• NIC CONTROLp I
ARCH]I'ECUENGINIJ;R AC NO^f/Y(//)_~ Al > SS �r J ❑
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CONTACT PHONE BUILDING PERMIT INFO ,
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELBE PLUn1B MECH
❑ ❑ ❑
LIGIiN$ED CO N1 DECLARATION QTY" 1 'ELECTRIC PERMIT, t, i, �f FEE' ,1
I hereny anion mm I am tin„•ed.niter pm.nmns of Cnap,er 9(rommeming I ::„r... . . : r - JOB DESCRIPTION
of�z
wish force Division3nf the BUS,nexnnd lhnkssmm Cne, dm RESIDENTIAL:
y]OO .psi PERMIT ISSUANCE F�F ,n full force end eQes�^� /l 'Z(�� �J cis x ❑SPDN'1, ❑KI'fCIIEN REMODIiI.
�UU License fss C� L:c p a._v APPLIANCES-RESIDENTIAL I ❑ADDITION ❑PLUMBINGRETIPE
F W Dole Comr:uvir
FOy A CHIT BET'S DCC O PANELS )MULTI-UNIT 0STRUCTURAL
ZO°jZ Iondontaadmy plans shell he used a•pit rrcml, M11QDIl+(CA'('I)N
OZ=� DP'IT)21U AM1IPS ❑INTERIOR ❑CHIMNIeY REPAIR
F�(CF
1+ ,Cem°d
+ 211-I0I0AMYS l IMPROVEMENT SWIMMING POOLS
2d OWNER-BUILDER DHCL RA1'IO ' ❑13ATH 11M1ODEI IRE'AIR 0 DEMO.'I'[ON
E5 hereb y e mat R-exemptf ar',he List, OVER I(MNAMS
�0Nndsi Lac use Lau m SIGNS ELECTRICAL ❑OTHER
fallowing mason 7031.5.Businea and Y my
6131a I'” whleh rc9itires n"LL In conannt,filer,In,praw,dentoloh,Limiter any I..nlm. IL W
0 mo,1. ,," a,mr,al so reepereslheapphcam lorsv.h pennnm Olcaagned.mmmenn SPECIAL CIRCIII'1'IMISC
flyHim hen heriordpunuanuo the pmvteomofthe Commerce,License Low(Chapter 9
fya� (camnsnemg with Section 7000)ofDm.vnn 3oflhe Bu siness and Poom,smns C,uL)or THMR METER OR POLE INS1 COMMERCIAL:
Y Oo O4., thal he n exempt therclrmn and the non for die alleged exemption.Any violation of ❑NEW BI,DG/ADDITION ❑DEMOLITION
�-„W Section 70315ny any epplu-nt ho.peoulwedid,the ap1d,md ion civil pcmBpofl POWER DPVICILS QTENAN'1 [I FOOD SIiIIVICIi
at, not more than five hundred dollars($5000 IMPROVEMENT
aC ❑Las owner ofthe pmpeny,or my employees with wages es their sale compensation, SWIMMING POLL ELECTRIC nil
H will do the work,and the•mlcmreis not intended or altered for asle(Sm.7044.Insures.
�OTHFR
T"2 ,red Pmfesaon•Code Tim Conlraclors License Lew Jue•not apply In eii owner al OU'11.11'0-SWI ICHES-IIiX'1'URFS /!
a 3
property who builds or Improves thereon,and who does wrh work himself ar thmug..
his own employees.pmvtded that such improvements an nal,mended or aRcml Tor NEW RESIDENr1ALGLECTR SQ+1', f'
sale ff,hnwcsegtne hnJJ,ng onmpmvmnem n.nldwuhmone YCandcompinmglh, - �/ SQ 17 Fl
. .00RARHA LSQ ImI'
rywnernaunm wdI have me names sir pravi,ig,nal tie inn Ian na,1d onmrnee her par- .
,mofmle.) -m um S� ��, P A I D
El 1,as owner of the ppert am exclusively contracting with hummed cumlaclors t9 ( TOTAL /
confirm.,the p,,,act(Sec 764.Bovi end prof e•aon.Cade 11 he CnnlmmulL L,- „ .. ..
eenLe low noes oat eppty U'an owner of progeny who nuiM•or i,npnvea lnerom,,end QTV.1;'' •� ,_PLUMHINGPGRMIT ',I I ,. PEF `7 ��� �g
who coulmcts for such plodded with a contractors licensed Pursuant m the Comment", Dl/fad
Lueme Low. PERNUT ISSUANCE I REC(�
❑I ant exempt under See .B&P C mrlhn reason )
AL'I IJi-DRAIN&VENT-WATER II?AI rlry 1;; tel9T1'Cgn'gglyV
Owner ^IO
WORKER'S COMPENSATION DECLARATION rdbasON BACK FLOW I'HOTGCf DEVICE
1 hand w affirm under penalty of of ury one of Ism following Worderuum
00 unnedl mein by Suclum 37 fie of he Lesttm Code*fore forced. sle,of the DRAINS-FLOOk,ROOF.AREA,CUNU. S'IORII;S TYI'Gg1NS'fRUC'I'101
worn,as pmvtded for by Se<tinn 3700 of the IsMr,Ciide,for the peRnrmsncc of Nc
work for wbch nhis permn,s nwttl, PIX'I'ONES-PER TRAP
❑I have unit win nu,mam Worker',Cnmpcmelion Insurance,f•cloned by Section
37L'oof the Lalwr Code.for die perlormanc ut the work for whuhlhn peminlnnsucd GAS-Ii, SYSIGM-I INC 40UT11. CC GROUT' APE
h+4.WOrAcfs Compenseunn lnsumnce comer and Pobcy number ism
Carer I'ol,cy No GAS-IiA SVS'1'IiM-OVER•1LEA)
CER'I'IFICArE 017 EXEMPTION FRONT WORKERS'
COM1+PENSATION INSURANCE GRCASDINDUS'I ILL WASTE INTGRCGITOR
BmLnlrvc Dlvlsu)ry Frus
(This SCCUOn nerd not netampined lone permit is future hundred dnllun($1 00)
or do.)
GREASETRAP
PLANCIIECK THE l
lenity Paton lholanortn:recut the wad farwmrhthapermt,,lc, d,]shop SEWER-SANITARY-S10RMEA,201FT.
not emrloy any pen on m y nner Loss In become hlyy�to Cn,npen- ENHRGY ITT
z Ovation I�ws of fn tee r'O' .1 WATER HEATER WNENI'rELECTR
O0 NOTICm /A 0.. / GRADING IIIE
NOTICE 1'O LICANr II,u cr g IM1IS Cem�icatc n(Gsentption,you should WA1 ER SYS'IEMITREA'I'ING
a ; hecmnc sun r to the Worker's Compensation pavikk its of the Iahor Code.you must SOILS PIJi
fonhwnhro ply with such poevmons onbt5 permnshall hedearod its Med. WATER SERVICE
W A
� zCONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLUMB, SQ.FT (PAID
U 0 ]hereny off irm batmere is a Lom,...;itm lending agency l or the performance of Dore Be' l
the work for which this Permit is issued(Sec 31097,Civ C I 1
F" Lender',Name ��- T AI.
kULender'I cenify 'TDTA L: /
U I certify that 1 Leec real lhn uppbcannn and etxic that the shore,nlnrnunum n 1 BUILDING PEE
comect.l agree to comply with all miy and county ordinances andslme lawn miming no QTY. MECHANICAL PERMIT 1'IiF, j
V Z building construction.and hembyamorme mpnsentaavexufthts city loenteralxmthe f SEISMIC FIiF.
aMVe-arearned pmpcny for mpccaon pomace• r PF.RNUT ISSUANCE /
I Wc)agree a cave,,nJmnnip and keep Wrote"the Oly nl Cupcnlnn ngmnat II IiLECTRIC hli
habdmes,Lidgments.costs and r,pemes wlochmaym any way acme against aid City + ALTER OR ADD TO AIECH /
in consequence of the creating of this Penn. I'LUA101NG FLUE ��+
APPLIC NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(1010.00007M) MECHANICALPEI/ S V
SOURC.R ULA NS
7 AIR HANDLING UNIT(OVER IB,SX)CFAD CONS]RUCTIO111'AN
9gn: r fA11Ii1duJC. to 1 Date F.XHAUSTHOODOYMUCT) IIOUSINO MITI TION FF.E
IAZARDOI MAI ERIAI.S DISCLOSURE
dl the applicant or future building occupant slate or handle hazamou•numeral / HEA'T'ING ON I I'1 TO I IXLIXx)BTU)
m of eJ by the Cupenino Municipal Code.Chapter 412.and the Health and Safety HEATING UNIT'(OVER IIXI,IXXI BIUI
C e,Seel,nn 25533(c+
�YL, F-1 No PAID --
VENTILAI']ON PAN(SINGhF.REST DI Date Rc
WIII the aildicam or fmure huddmg oacupxnl ace equipment or desires which I n•,p
•emu hammnus sit cantammantf e•defined by the Buy Area Air Quality M1ltmugement RDILIiR-COM1IP 13HP OR I W,IXNI BTU( ,IOTA(
Dumo t
❑Yes Fl No
k011.liR-COMI'IUVIiH IOgfX10❑Till
-
I have refit the Licari mmlered,n9tiiremenFUnder Clt.gner 695 of the Cab- AIR CONDITIONER ISSUANCE,DATE
torn,.Health&Safety Code,See, us 505,255)3 and 25534. Rthe
NHW RESIDIiN I IAL MI U.
building does not currently have a tcnL,hat n is my responsibility m notify the occNl SQ Ire.
of the mgmremand whwh mot he met prior m usaamm of a Comfime of Occupancy
Owner or sauntered agent Date TOTAL ISSUHD BY
OFFICE