29920APPLICA
CITY OF
BUILDII
CONTA
p4z witaS
in full In
License
Dale
atiy
FILL IN'INFORMATION WITHIN. RED LINES - USE BALL POINT PEN ONLY
RTINO '` BUILDING- RI.RCTR
ISION"' APPLICATION/PERMIT - PLUMBING. MECHA1
BUILDING PROJECT' IDEN9
d. Ty PERMY
All
CATION
SANI'T'ARY NO. APPL
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uLICNO. ADDRESS:��
.PHONE.
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q�ta qi 0 Coault
eant Pees Paid by Applicant (Initial)
LICENSED CON 'I'RACI'OR8 DECLARATION - LQTY ' ELECTRIC PERMIT f " FEE '
affianathallarm licamedud provisions ofChpt 9(commencing
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A))ofD 3 Rhea one: IP Caston d d ylu ,L P('RMIT ISSUANCE : 3
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1 a# I APPLIANCES -RESIDENTIAL -
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A CHITF,CI SIlF61A[ O
ZpV IundersNnd my plans sM1all be used p hbe records „ PANELS •y-
OZ� UP T0211f1AMPS .
dyF.2lOi�1
2111-1000 AMPS
Licensed Professional OWNER
-BUILDER DECLARATION
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1 herchy affirm that 1 am exempt from the Coo rachas. License Law focthe OVER IOOOAMPS
316
following reason (Section 7031 .5, Business d Profession, Code Am aquarium, SIGNS EIEC DUCAL
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whom reclaims. P its. eceirmal.site, m,m,c;,dcmfi,h, morairy:l core .
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I, i—trinue, ficrouhp 't 11c
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peers alsonequacshe ppl' to a,i8nedoinearral SPECIAL CIRCUIT/MISC.
that he licensed ptt the provisions ofthContractor's LL (Chapter 9
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(cum g lh Sect 7") f D' iso 3 of the Basuto. d P f s Grade) or TEMP. METER OR POLE INST. `
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that he c.ampt ffieacfuaa coal the basis for the alleged sear,foin Any violation of
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Se c hou 7031,5byay ppI t for a perart subjectsthe applicant npe Ip of POWER DEVICES
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ni than five hundred! dll . ($500L
1 rte fthe p perry, or, employees with wages a,th od, cinipturVaitin, SWIMMING POOL ELECTRIC,
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is if do the work and the structure is not imeraird oroffered for vol (s 70,PL Business -
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and Professions Code: The Contractor's License Law does resupply to an owner of OUTLETS -SWITCHES -FIXTURES -
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property who builds or improves thereon, and who does such work himself c rrhrough' ,
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his own employees, prb alcd that snahLimprovemem, are not intended or altered for NEW RESIDENTIAL ELECTR` ', .,SQ Fp.
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sale. If, however, the building or improvenich is sold within one year of completion, the
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er-builder will have the burden of proving that he did not build or improve forpur,
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pose of sale -L °
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Fl 1, as owner of the propmy, um exclusively contracting with licensed contractors in V A
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c onstmet the project (Sea 70JQ Brsieess and Pmfevsions Codep lite Comraeaa's Li- -
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wLaw deoat apply to an owner of progeny who builds or improvev thereon, and QTY, - I PLUMBING PERMIT- wnm
ue+,mraels busueh pmjeets with accomector(s) licensed pursuant m the Contractors
License Law. ', PERMIT ISSUANCE
0 lamexemptmnder See, ,B&PCmrthisresam
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Owner Dom ALIER-DRAIN & VENT -WATER (EA)
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WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT. DEVICE
I hereby affrrn under penalty of perjury one of the following declarations,
O l hevennd will maintain aCcurfi le of Consent to lelf-insure for Worker's Cooper-, DRAINS- FLOOR, ROOF, AREA, GOND,
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sation, as provided for by Section 3700 of the Lahnr Code, furtive performance of the
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orwchmi,proohisicmed. ••: FIXTURES -PER TRAP
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I haveand will maintain Worker's Compensation Insurance, as required by Section
37 f the labor Code, for the Performance of the rk for which thipermit is issued." I GAS EA SYSTEM -1 INC. 4 OUTLETS
My W kt rl rciturne, carrier and P sic
Cnrri sX�ri� PI'yNd� GAS LA.SYSTEM-0VP.R4(EA)
CER1111 CATEOFPXEMPTION FROM -
COMPENSATION INSIIRAN GREASUINDUSTRL WASTE D TERCEPTOR
Ovineroiamhmized clear - Dale +
OFFICE
` ITh':' tion nand not becomplesed ifthe perms ,fin one hundred dollars ($I W) ,
GREASE'1'RAP
-
Iecrl Cyt m pe romance nflhewrrkfor whmml Permit s sxurd,lshall
a,cnPloyan a -n lym4nn 519' Ip9 me Workers Camper- SEWPJt- SANITARY -STORM HA.2W PI'..
sation Law' i ��,
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Appbcbnl WNI ER HEATER W/VEN'UELECfR
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NOTICE APPLICANT If, after ag this Cecaric"e of Exemption, you should WA'1'HR SYSTEMOREATING =
becour, Workers
caneu m rho Crary moan proven ions of the Labor CWe,.ynu mull
ear
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fonhwitheomplywilhsuch Flrovisid thiopermit sMi116e deemed revnkeJ."I- WATER SERVICE
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CONS 'fRUCr1ON LENDING AGENCY NEW RESIDENTIAL PLMB. •y SQ. FP
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'.f IherebyafOrmlhat them is a coommenon lending agency for rm
the e ,
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Ina work for which this ,air is issued(Sr,3097.Civ.CJ
he
Name' -•
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Lender's Addmss TO AL'
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'1 cert y That 1 have read this application and Stam that the above information it ,
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correct. I agree to comply with all city and county ordinances bad stale laws relating to QTY MECHANICAL PERMIT
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building constriction, and hereby anmorize representative' of this city w enter npatime
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above-mentioned property for inspection purposes.
PERMIT ISSUANCE
(We) agrach, save indemnify dad keep minutes, the City of Cupbnmo against
Ilabllilies,judgmenis,costs and expenses which may in any way accrue against said City ALTER OR ADD TO MECH.
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nsasicar eof the gratningof mispermu.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Alk HANDLING UNIT (TO 10,000 CPM)
SOURCE REGULATIONS.
AIR HANDLING UNIT (OVER 10,000 CFM)
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Signature of ApplloantlConhuctor Dale EXHAUST HOOD (W/DUC'T)
HAZARDOUS MATERIALS DISCLOSURE
Will the appllcum or future building occupant store or handle hazardous material r HEATING UNI 'C(TO 100,000 BTI
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as defined by the Cupenum Municipal Cod, Chapter 9.12. and the health and Safety
Code, Section 25532(a)?' - HEATING UNIT (OVER IW,OW HT U)
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• ,. VENTILATION FAN (SINGER RES ID)
WIII the appliwm or future building oecurym ossa equiPmenlbr devices which
emit haurdoirs sir commnlnama us deEred by me'Eey Area Air Qublity. Management' BOILER -COMP OHP OR I0oxo BTU)
Distrim7
BOILER -COMP (OVER 100,000 ETU)
❑Vas- , N�n.
Ihuve read the nnzurdours mamniahre AIR CONDITIONER _
q m' de Ch Pm R95 fm CWi-
ria H Safety Cotlo, Sea env 25505 255'i3 d 25534 1 d l d th t IC Ito° NEW RESIDENTIAL MSCI{ SQ. FT.-
biiltll' drc twnem lenam mm t yrc:q h'I tyt Ffym cupant
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I .vi he-men priors i:uance ofn Ce�em�(rOai�n� - ,i
Ovineroiamhmized clear - Dale +
OFFICE
`FEE - " ��g
PAI .0
D�?.
VALUATION
0v 0 1269% and
allu
PLANCHECKFEE'
ENERGY FEE
GRADING FEE
SOILS FEE,
PAID'
Dale Receipt is
BUILDING FEE /
FEE SEISMIC FEE '
ELECTR E
PLUMB
pH`s ,MEC { FFE � w
H CONSTRU(' ION TAX "
'110 SINt PIIf ATION FEE
wt "
rviYV I IV VVI
PACO
De Receipt#
T �
ISSUANCE DA'
ISSUED BY:
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'• JOB DESCKIP"CION
-RESIDENTIAL,
QSPDWIL "❑ KITCHEN REMODEL
OADDITION OPLUMBING RE -PIPE
❑MULTFUNIT L1 STRUM URAL
MODIFICATION
[_1 INTERIOR ❑ CHIMNEY REPAIR'
IMPROVEMENT
❑ BATH REMODEUREPAIR ❑ DEMOLITION
❑ OTHER
Ig
COMMERCIAL
0 NEW BLDG/ADDITION 0 DEMOLITION
OTENANT 'r ElFOOD SERVICE'
IMPROVEMENT
❑OTHER
„
`FEE - " ��g
PAI .0
D�?.
VALUATION
0v 0 1269% and
allu
PLANCHECKFEE'
ENERGY FEE
GRADING FEE
SOILS FEE,
PAID'
Dale Receipt is
BUILDING FEE /
FEE SEISMIC FEE '
ELECTR E
PLUMB
pH`s ,MEC { FFE � w
H CONSTRU(' ION TAX "
'110 SINt PIIf ATION FEE
wt "
rviYV I IV VVI
PACO
De Receipt#
T �
ISSUANCE DA'
ISSUED BY:
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