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S 1386 � APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITYOFCUPF{�TINO NOII.DING-Y:LECI'HICAI. Pt�QITNO NlULnINc DIVIS1oN APYLICATION/PF.RMIT r�.uammr..ux:cxnN�cn�. J . 1�8 6 19111.D1%f:PROJF.C'P II1F.N'1'IN9CATION SANITANV NO. APPLICATION SUNMITTAL UATE " AUILnING ADDRESS �i �b� -�.� �.m�y 3-�( �� � OWN�R:SNAME: 0 0�.� �IONF: � CONTkACfOR'SNAMI?: LICNO: N�� CONTROI.M T � �/ � \HCHITGCI'ILNGINIiI?R: LICNO�. Alll)N05S: ����q�; PHONE: 6 ILDING PERMIT INFO J�r O,N6 �^', f�3 9 y�� ❑ ConsWlant Fees Paid by Applicant Qnitial) eu�G Eu[cr PLUMB MeCH I i, ❑ ❑ ❑ LICf:NSEDCONfRACIOR'SDECLARATION QTy, ELGCTRICPL'RMIT FF.E JOBDESCRIPTION 1 hcrchy aftlnn�hm I um Ilcensctl unAcr pmvixions n(Chvpicr 9(wmincncing �aZ wiihSec�ion]000)nfDivisionlnlihcBosincz,�vndPmfcsninmCwle,vndmylicroscis NFSIDFNTIAL� �y�� PGNMIT ISSOANCE ' F�y infulllorceandeRec�. ❑SFDWL ❑KITCHENREMODCL aUV LicenscClnsn Lic.M qPPL1ANCES-NESNENTIAL ❑ADDITION ❑PLUMBINGRE-PIPG NaaDuie Commnor ❑MULTI-UNIT ❑S7RIILTURAL > ARCHI'PFiCPS I�IiCLARATION PpNF:IS MODIFICATION I 20yq �undersundmyplanslwllbcuu4aspuCliercened � UPTOIWAMPS ❑IMGRIOR ❑CHIMNF:YREPAIR OZ^O � F.,'�'„��y LicennWPrnfc�sionul 201-IINII�AMPti IMPROVfMENT ❑SWIMMINGPOOIS � �,j�; OWNER-Nl11LDF.RIIECLARA'1'ION OVfiNI(101)AMPS ❑BATHRIiMODLIIRL�PAIR �DNMOIJTION C�Q I hcrtFy a(finn iha�1 am exemp�frnin�ne Cnmrn<mrs Liccnse taw lia ihc ❑OTHCR °x'�a U Inllowin6 reusoa ISwiion]03L5,Nusinccr und Ihvfessinn.Caie:Any ci�y or eoumy SIGNS LLF:CfRICAL Y73 fa�"' which myuims a permii w con.enic6 ulmr,improve,dmnnlieh,nr repair uny mmmure _ � � �"��� pnonoikissmna.oknrcquiresihcepplicuminrmchpcnninnflcusignWnmmmem SPP.CIALCIRCIII'I'/MISC. • ��QD�y mmne�.u�r�uan�R����om�pm.���on.�nn�conw�mr:�.monK�wtcn�r�M9 COMMCRCIAL: (commencinywiihSenian]qlepnfl�ivixionJnfihe0usinessandRofessioneGdc)oe TEMP.MET[NORPOLLINST. y Xo y mw hc i.v cxcmpi ih.rc(rnm and iM1c M1asin Inr�he alle6�J cnen�piinn.Any violnilon nf ❑NEW HI.OG/ADOITION ❑DEMOLI'f10N ��„NSwlion]IqLSbyunyupplicnmli�ropermiisuM1jectsiFeupplicnnimucivilpenol�yof PO iltDEVICi?5 ❑TLNANT ❑I�001)SIiRVICf oi mom ihan f vc hunJ�ed dNlen(55001. IMPNOVEMFNT �Zq �I,asownerof�hepmpeny.ormyemployceswitiwoses¢aNeirsolecnmpenvaion, 'IMMINGM)OLELECfRIC will dn�he wnrk,unA ihc mmemm Is no�imen�cd or nRercJ for sale fSaa"l044.Huxiness ❑OTHF:R I�i1�� und Pmfcssiane Gde:The Contmcmfs I.i<ense Low Jncs noi vpply m an awncr nl' '��. tiWll'CHES-PIXTURIiS 6 3� pmpeny wlw builds or impmrcs ihereon,unJ who docn such wnrk him.tlf or ihmugh his own em0��y��s,pmvidN�hm mch improvememx um nor imenAed or ullemJ for NEW RFS EI.F.CTR SQ FT. sole.Il',huwcver,ihebulldingnrimpmvemcmlwsoltlwiiLinonoyeurufrompio�inn,�he SQ,FItFL00RA0.RA USQ.F1'. crvhuilJer will havc�he buNcn nf prming ihut he JiJ noi huiW or impmve fnr pur , ��wn fv9u). TOl'AL: . 1 �v awnerof tie prapcny,um eticlurivcty cunwning wiN IiccnsW wm�ciors m cnne�mc�ihu prnjmi(Scc.9M4,Pueiness imd Profwsion.COJe:)9fie Cnnvne�ods Li- enseLuwa«�noiupr�Y�o:�nowncrnrpro�nywnohuild.nrin,prove.,mero��n,ane QTY. PIAMBINGPGRMI'f FIiE i whommmnsforsuchpmjeciewiihawnvaaorts)Iiansedpunuumm�AcCnnirecmrs ' I,irenscl.uw. PF.RMITISSUANCG i ❑IumuxcmpiimdcrScc. .BdcPCfinthlerwson N;1'fiN-DRAIN.@ VENT-WATHN(IiA) VALUA'fIUN �I Owncr polc WONKER'S )MPENSATIONIl1iCLARATION BACKFLOWPROTECCDF.VICti / �D Q 1 hwcAy ufflrm macr pcnal�y o[perjnry nne nl the fi�llowiny�eclueatlnne � ❑ IhnveondwillmuintainaCcnificamnl'Cnnsenunu9GinsurclnrWorker'sCnmpcn- URNNS-PLOON,ROUP,ANF.A,C�ND. 59'ORI[ti TYPECONSTRIJCfION sainn,uz pmvideJ fnr hy Senion A1M1 of�he Labor CWe.for ihe pednnnance of ihe work Inr whieM1�his peemi�is ixsucd. Fl%TUNES-PGR TRAP �1 M1nvc unJ wlll nwimxin War4cr's Cnmpenm�ian Inxurnncc,uw rtyuircd hy ticcAion 3900nI�LcLuborG+Je,fnnheperfoemenacnlihewndlnrwM1ichihispe�miii.�issued. GA1-F.A.SY5fIiM-IINC.40V1'I.I;I'S pCCGHUUI' APN MyWmkels Compcnxalion Inxurnn¢<arrier end Poliry numbcr um: Cnrdee Poliry Nu.: GAS-LA SYS'[EAI.OVLN J l'�) CfiRTIFICAICOPEXEMI'TIONPHUMWOHKIiRS' �g�qqyFnNDIItiTRLWASTLINTIiNCRPTOR COMPfNSATION INSURANCE HUII.1)INC DIVISION FIAiti � (ITisua�innnadno�hecompleicdif�hepenniiisfnronehmulreJdollan(SIW) �gGSF.TRAP I orle.sJ YWNCHGCKFE[ . Y ' cJ.ISM1aiI SIiW1iR-SANI'1'ARY-STORMtiA.2tN)f�l'. I�nif ihmintheperfnniwmeaf�hewodfnrwhich�hixpernii�isiscu LN2ROVPF.E � nol employ ony pennn in nny mannet so us lo hueome wubjwl m ihe Wndecx'Compem � Z ��ionlywsofCalifomia.Dam WAl'GRHF.ATIiRWNCMP/[L[CfR GNADWCPLF. I z� ApPlicvm NOTICC TO APVI.ICANT:It,ufmr nmkiny ihie Crnili<me of F:xcnip�ion.you xhoulA Wq'pFR SY5fiiM/fREATING SOILS F[F. F � M1ecome suhjuuo ihe Warker.+Compennminn pmvisinn.s of We I.oM�r Coae,ynu mmi � � fonhwiihcomplywiihsuchpmviziansorihispemii�shull6edeemeJrwokeJ. WpTLRSERVICC I � Q CONSTNUCfIONLFNUINGAGIiNCY NfiWRE51UiiM'IALPLMIt. SQ.FC PA�� � '~�' IM1erebye[tlnmhniiherclnecon.wc�ioulenJin6vgeneyl'nnhepednnnunceof Dum Rccclp�M I � � Ne wad for which ihis permi�i.issueJ ISec.JO'A.Civ.CJ TOTAL: Q V ��a�r,rmm� Lcn�cr'sAddmse T��L� W 1 cenify ihm I have rtud ihis applicmion and nime�hu�tbe uhove inlirtmnlion Is IIUILIIING F L �' g pywi yan yo B QTY. MLCHANICALPERMIT PEE Vlcorteci.lerte�umml ��allcii Jcoum NinanttsanAsieielawsrtlain �o SEISMICFE �.1 ,7a. buildln6�^�swninn,and�erebyamhonzcrcpresema�ive.of��iscitywenmruponihe nbove�nmmioneJ propeny Inr in.pec�ian pumoses PLNMIT ISSUANCE LLECI' C FEE (We)agrce in wave,inJcmnily and kcep harnilen.�he Ci�y nl Coperiino ugainsi �D IiaM1ililics,jutlgmenlc,cos�senAexpenxswhichmayinunywayucemeagaimlwiJCiry q�,TGRONAUUTOM1iCfl. PL I E " mcqurnttolihegremingo(Ihispcnni�. APVIJCANTl1NIlfiRSTANU$ANDWILI,COMPLVWITHALLNON-POIN'1' q�µHANDI.INGIINIT(10IQ(XM)CFM) M ALP[li SOUHCC RECUI.ATIONS. AINHANDI.WGUNITIOVERII1,INpCFM) (�N �❑ �py��p����� I ISI�Y SignnmrenfApplievnl/Cammnur Iln�o IiXHAU5TH60D(W/�UCfI HOUSINOMITIGATIONFGG HAZARDOUS MKI'BRIALS UISCLOSUNii WIl�heapplicamnrfwureWilJingmcup�mnmreorhunJlchazaNnu.maenW HY:ATINGUNIT(TOIIAI.IMqBTU) az dclineA by�hc Cupenino Municipil CnJe,Chopmr 9.12,vnJ the Henlih und Safery H[ATING UNIT(OVER I W.001)II'fU) CaJe,Sce�inn 255J21u)'! ❑Yes ❑No VLNTILA'19�NFAN�tiWCLEN1iSID) CA�n Dam Ncvcip�# Will Nc vpplicam nr Powre builJing occupam usc cquipinem or Jcvims which tlO1l.NR-COMP(3HP OR IOO.fM10 fiTU) mi�hv.nrdaur uir con�aininunn as detinaJ by ihc Itny Areu AU Quuliry Muno6ement T�TA�� Disvieft pO�L[R-COMP fOV 13R I(10,(100 flTll) � ❑Ycs ❑No I hwc rc:W ihe haznrdnus mmeriul.rcquimmemx underChap�er695 0l the Cnli� A�N CONDITIONER ISSUANCF.DA/Tf7i fomiu IIceIN&tialcry Qde,Senianx 25505,255J7 anJ 2594.I unJersmnJ�hm il�he NIiW RESIDIiNT1AL MIiCH. SQ.FT. �i�/9.�Q.-b( buildingdcesnrncuncmlYhuvcucenenLJio�i�isnrymsry�mibiliiyionniifY�M1eompum ( ( O� of�he myuirement�which mm�he mei pnor�o issuanee of a Cenifca¢of Occupancy. , )1 �A OwncroramhonzcJaBem Datc TOTAL: .ISSUIiDHY: ✓O� � � � (l OFFICE