S 2614APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
CI•PY OF CUPER•PINO BUILDINI: - ELEC'IIUCAL
nU1L)ING DI VISION APPLICA•1'IONIPE:RMIT rl. -,%.! - TIDFNOFIC _
IIl11LI11NC. 1'NOJIiCT IDI!N'1'IEIG1'1'ION
PHRMIT NO.
S 2614
'
�AR
BUILUINGADDRISS: //
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< J <� 32 io9
SANITARY NO.
AI'1'L[CATION SUBMICWL DATE
—2 - l�
O 1�[JtS NAME: PHONH:
CONIRACORSNAME: LICNO:
NIC
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❑
Consultant Fees Paid by Applicant (initial)
•BUILDING PERMIT INFO
1t p ELECT PI limit MECll
e� ❑
LICHINSED CONTRACTORS DICIARAIION
I hereby aB nal that 1 am ficenwd under p is febapler 9 (commencing
Ili Seu'or 9000)ut DM6 3ofhoBoa r and lrofe's'ois Qxleunilicnse,
WI
n full li c ,.ad cpict 7o 17
I.iccnre Gbs Cm,N J
Da¢ CarlrvOnr
QTY
_
'ELECTRIC PERMIT '-
F-E
.IOd DESCRIPTION
RESIDENTIAL:
,,., /�
El SFUWL ' -ercl IuN RPMoobl,
❑ADDITION ❑ PLUMRING RE -TIFF.
❑NIULTI -UNIT El Sit RUCTURAL
MODIIHCA'I'ION
❑INTERIOR [I CHIMNEY REPAIR
IMI'ROVEMI ?NT SWIMMING 11001 -S
H kBMODEI /RFIW IR OIiM01.119ON
OTHER
PFI MIT ISSI IANCI:
APPLIANCES - RESIDENTIAL
ARClil'I'I?C'I "R DECLARATION
1 nnJcrslanJ my plans shall her as public rcaords
PANELS
UP TO 2(NI AMPS
L.iccnxcd Professional
OWNER- IRJILI)fR DECIARAI'ION
I M1erchy affnn hbm 1 am exempt fmm name ComramorV Licenzc Law for tlm
fallowing reaso n. (Seen 7011.5. It¢siness and Pmfessiuns Code: Any city or counny
which requires o permit to construct, alley, improve, demolish, or repair any ttmaturc
prioneas itommoa, al...... mir, Itheoppliaml for sact, ".oi, la Eleusignul stmennem
that he is licensed punuanuo the Tomisions of the Cnnmlcmta License Law (Chapter 9
Rommenci ng wit b Section70nd of Divirine 3of the Brimsxnnd 11... nine,Code)ur
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any upplicam li+r a permin eabjr,l, the oppGCUnt to a civil penalty of
of more than EVC hundred dollars ($50d),
❑ Laso. .... flbcpmpcny.onny eoldnycaw.11, wagcses I'tirsnleunmpen.wtian,
will dmhewark,nndthcammurc is oat imendedornRerud(inside (See. Balb! business
uad Professions Cod, the Contractor's Leon, Law arcs no apply in an owner o
propeny whu hulas or Improves thereon, and who does such work himself or drying
his own employees, provided that such improvements are nil armored nr idl oal In,
sale. It. howeveglhe huildingor in+pnrvemam issold w ithin on e.o of completion. the
er- builder will have the harden of proving Nil he hot nod build or Improve Imp.,
pose of sale.).
O 1, os owner of the propeny, ant exclusively ecours ling with dler rd contractors to
m.hao the "natal (S¢. 71413, Bovines. wad Prof essiuns Cod,) the C ... I (s Li
meL.awdaesnal...Iyute..umnarof pm,dywho builds nr, imp r vevhancna and
whoeantraels burner projects will, a cantiou, (i)licensedmrsuumta0m Gan memr's
License Lau',
❑ nod es...... onner Sec. .R& P C f+r this act n.. a
201- 10N)AMPS
OVER IOW AMPS
SIGNS FLECIRICAL
SPECIAL CRICUI'I' /MISC.
TEMP M ETER Olt 1'01.17 I NS'I',
COMMERCIAL '
❑ NEW BLDG/ADDITION ❑ )I?MOLITION
❑ T17NAN'T ❑ FOOD SERVICE
IMPROVEMENT
❑O'fHElt
POWER DEVICHS
SWIMMING POOL ELECTRIC
- 3
011'I'LP.'fS - SWITCHES -l:1 X'1'UI<I ?S
NEW RESR)EN'TIM. ELECT SQ 11..
SQ, FT. IROORAREA
•VSQ. FT.
QTY.
- ° PLUMBING'PIiRMIT
FEE "•.
PFRMI'I ISSUANCE 3
!A-�
V
ACIER - DRAIN & VENT- WATER (EA,)
Owner [)are
VALUATION
Q
WOR KERS COMPIiNSATION DECLARATION
Ili by B at l Plot IIyofl+ l Y f0"1"1 gJ l tens
❑Ili eve and will maintain a Cofineof Consent t dfins for WaTkee% Compen
Odam, a, p. invited h+rlyS f 1700oldic Lot Core, r, 1he perbamanceol the
work for h hth permit ':ud,
IN11 U 'It maintain W k. Cimr,anoai ruer. a, r crooned ' by Semi.
of,he 1 M Code; Ifforth Iwrf once flh work for which tyh,' permit is'.med,
My Wfr4. fjF NA nail y/J. ..tannic l'oi'n 'y No.Y.Z.(zy<
vYnlZli' d
�;ICATCOFEXIiMI'1'IONIROMWOIt l!R5
COMPLNSA'I'ION INSURANCE
(Thi-cOmnmxJnot M1ee ridemdiohepermilisfnr nn elmmb ,ddollws($yXd
ur less)
I verify ilia, in the performance n0hc work for which this permit is issued, l shall
net employ any person In mry meaner sn as m her o.re xobject to the W a ars' Compen-
smion Laws of Czlifomia. ')me
Applicant
RACK FLOW PRGI'ECT. DEVICH
DRAINS FLOOR, ROOT. A R FA, COND.
STORIES
'I'YPI3 CONSTR.C'I'ION
FIXTURES TER 'I RAI'
GAS L'ANS9 }yhpLLN!(±.'pOOT�'I•
OTC /f /1�.'ROUT
1
(f MIN
,o 2(�
^F / Y/
GAS -E C'S STEAM 'A)
GRCASI }IND S'IRL WAS'1'1?IN'I'BRCI ?PLY)
NUILDING DIVISION FEES
(�
GRLASI. r+
PLANCHIiCK FFE
SHWER - NI'1'ARY -STORM IAA. 210 FI'.
'
ENERGY 113E
WA'IF.R H AIER WNENT 1I71.EC R
GRADING IEIi
NOTICE 10 APPLICANT: IC aRennaking this Certificate of liscmphinn, You should
became sahj,e, m the Wnda's C apensarioa provisions of pro Lohor Cade. You must
forthwith comply why such provisions or this period shall M Jenned revoked.
CONSTRl1CTIONLENDING ...... AGENCY
ILcrch Ili�n.hm NCrc lxnumslmalnn lunJin•u tonne rfnrmuncenf
Y a s gamy r<
the work tat which his pemnir is issued (Sat. 3097. Ci, C.)
Nmnc
WAIEIt S I4kpffr °"
WATER SERVICE
SOILS PEE
PAID
NEW RISIUIiNTIALI'LMR SUFI'.
Deere Receipt
TOTAL:
Lender's
Lender's Address
'I'O I
f O
BUILDING FEE
I certify thin 1 have mnJ H;is application nnJ elute awl IM1C above infonnaion it
arlyt
career. . agree m comply with .11 city it county untirunccs aadstme laws relating to
building eon hadion, and hereby uulllno to repe,cnhniveaof Ill, city to ca', npon lbe
ulwve- arodia ted prnpcny for inspection purpose.
(We) agree w save, indemnify.md keep Initiatives the Cily of Cupani..n agearil
liabilities, Iudgnrzms, costs and expenses which may in any way same against idid City
incanscyucnccofhhc gran..... rfda' Permit.
APPLICANT U 'DERSTANDS AND t' L COMPLY WITH ALI. NON -POINT
SOHRGE RF d PIONS.
10 �'
QTY.
MECHANICAL PERMIT'
FEE_
SEISMIC FEE
.
PERMIT ISSUANCE
ELECTRIC FEE
ALTER OR ADD TO MECH.
PLUMBING FEE
f /
AIR HANDLING UNIT OR) Iy0(M CPAO
MECHANICAL FEE
AIR HANDLING UNIT(OVER 10,000 CFM)
CONSTRUCTION TAX
r/�n
Si.natnr of Pl...... , c r Ia)le
HAZ )US MATHRIA1 S DISCLOSURH
Will the applivam aline building nceupam ,meteor handle Intentions mumrlal
as defined by the Cupcnino Municipal Cod , Chapter 9.12, and the Health and Safety
Code, SCal.on 25532ho1
C) Yes
Will the applicant nr It building occupam use esmpmmal or devices which
mil truant nue ai,,rra muow."iefnedh .Ito flu Anen Air Qml'u Mona mu
Y Y Y ban.
Di.arict^.
❑ Yeti ��Jn
I hove read the non n /y werials rcyuircmen.s under CM1:gacr ,95 if the C,.li-
ft Health & Safety Coda, Sechiom 25505, 25533 and 25534. I understood! that if the
building1 nod nemlyhuveulc.0 , i,l,oynespnns.hililym nnl fy.hc— Livial
/ft /iswh h�J�.�� ..psi woomareofa Cyli he of(k/�(PancY,
"_ �s
!D
EXHAUST' HOOD(WIUUCP)
HOUSING MI'I CA? '[ON FEE
I(BATING UNIT (TO 100TTM B' N)
HEATING UNIT (OVER Ig).(FO RTUI
PAID
VENTILATION PAN IS] NGhF. RISID)
Deere Rereipt
BOILER - COMP (3111, OR IW,(00 BTU)
C-
BOILER - COMP (OVFR 100.000 B'I V 7
AIR CONDII'IONIiR
ISSUANCE DATE
2 ^ C hi
Z '-( /
ISSUED BY:
NEW RESIDENTIAL MEET. SQ, Ell
TOTAL:
A n�
e
OFFICE