S 1554 .APPLICANTTOFILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLV
CITYt)FCUPF.RTINO , uuu.o�dr.-e�.ecrp�cn� � rr;qpprtrvo
nu��mNcnrv�s�orv APPLICATION/1'I3RMIT P�AM6ING-MIiCHpNICAI. ` 'I CC /�
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y�(y/i�7 t�u66 �ho� SANIfARVNO. AYYI.ICATIONSUHMITTALUATC
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C41RF.CT/2NOINEER: . I,IC NO: AUDRH55', �
CONTACT: PI IONE:
BNLDING PLNMIT INFO
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I hereFy allirm�ha�1 nm licensed under prnvixions nlChapmr 9(commenciny F�� JOB DNSCRII'"f10N
y�j�O wi�M19eclinn)IlflD)olDiaicion3oflheBusinessanJPmfeuinnsCode,ondmylicensei..
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FZLL] Oa¢ Cnn�mcmr API'LIANCCS-RGSIDENTIAL
m6a ❑AD�ITION ❑P UMBINGRE-PIPE
ANCHIT[CTSIIGCLANATION ❑MUI.TI-0NIT ❑STRUCI'URAL
O Z y 3 I undcrsmnJ my pinns nholl h uceJ xn puAlic rcrorJ. PANLLS
MOUII'ICATION
UN'102IXIAMPS ❑�ry�'Eµ�OR ❑CNIMNEYREPAIR
Q..F'41 L¢rnudlT�lc.�aunul 201.1(NI(IAMPS
�X� OWNf:R-RUILDERULCLAHATON IMPROVEMIiNT �SWIMMINGPOOIS
y a�y i hcrcM1y aff n�ho�I am acmp�(rnm�he Commnnr's Licrnse I.ew for�hc OVGN IqIf1AMV5 ❑BATH BEMODEIIRF,PAIR Q DIiMOLITION
X 3 6 F following masoa(Senion]031.5,tiusinea and Pndessinns CWe:Any ciry or coun�y SIGNS ELIeCTRICAi, ❑OTHIiR
«� �y which ruryimn n pernilt m conewci,oper,im pair eny simewrc
�„�y,p pmve,Jcmoli.h,or rc
��y� prinr�oi�sisuence,elsomquircs�heapplicumfnrsuchpermiimfilcusigneJ.�a�emem SPIiC1ALCIkN11YMISC.
y thn�heislicenudpursmnuniheprnvisionsnfiheCnmrac�or'sLianseLaw(Chap�erY
�0 (minmencinywith5eciiun]INIII)ofUivislon9ofiheHusinessondPrnfcsinnsC�wie)nr T9MP.MH'P�RORI'OLCINS'[ COMMPR IA •
6 L o C Ua�hc is exempi ihemfmm ond ihe M1asis for ihe alle6�a�xemp�ion.Any violation of ❑NEW BLIX'i/AODITION ❑DEMOLRION
��N Seciion]OJI.}byanyapplicum6ru�emi�eubjttte�hcapplicunnnacivilpanultyof POWCRDIiVICfS
FZD• ^"t'nnrcihunlivehnnJredJollars(ES(Ml). ❑7ENAN"I' ❑FOODSERVICB
�=pQl,asowncrofNcpropeny,ormyemployaswi�hwagesax�M1einolecompensa�ion SWIMMINGiY�1.ELECTHIC �MPROVEAIF;NT
y.Fo w'll�n�hewuvk,undihaswewmisnaiiumnJctlornlfcrcJfor.We(Suu.]fIJ4,i)usinevF ❑OTHfiR
a 3�o and Ihnfessions Ci�le The Cnni.acmr's Licrnse I:Ww docs nm epply m en nwner��1 OUTLF.TS-SWITCHFS-I�IXTfIRPS
pmpvnY who builJs or improves�M1eecon,anJ who Jixs such wuA himscU nr�hrough
his own enipinyeer,providrnl ihu�sucM1 in�provnmm�x orc nm imcnAvJ or nl1'creA fnr NF3W R2$IUHNTIAI,F.I.ECTR SQ FT.
wie.�r.n��w���..m�n�ua�„s��.�mp�„�em�m��:o�aw�m��oo�ye,.or�omri=uoo.m� SQ.FT.Fl.00RANFA LSQ.Ff.
owner-builJcr will huve ihe huram nf pmvin6�ha he JiJ nm hmW or imprme for pur
pose nf snle.).
❑ 1,as owner of Ne propeny,am exclusively comevaing wiiM1 IittnuJ commcmrs m TOTAL T A ' D
onwinst�hc pml��(Scc."/M4,Bminess anJ Vmlc<�inm GNe:)Thc Comraqor's Li� �� �
re .cLawJ�exnmopplywunownerofpropcnywhonuild�orimpravcsmercun,onJ QTY. VLUMBINOPERMIT PEE
xhommncisfornuchprojeaswiNeconirnoqs7liccnudpursuannn�heCammmn/s APR 23
Lianae Luw.
❑ 1°'"BMO���r���e��.sw. ,e�rcro.ie�.re�o�, P�'RMIT13lUANC13 ��
ner ' Uae ALTIiR-DRAIN&VENT-WATEH(EA) V�A,IJA1(N
WORK2N'lC VENSATIONDIiCLARN90N �� !•�Y4Iµ
lhemhynfiiemunderpenali f HACKFIOWYNOTF.CTULVICE �
yo p juryoneof�hefMlnwingJeclarn�innc
❑ILavennJwillmuinmmuCenillemmfCnnscmmnclGinmrcfnrWurkarvCampem DRAINS-PI,OOR,NOOP,ANBA,COND.
smion,as provided Inr hy Senion 31q)uf�he Iabor CMe,fm�he pedoemance o!ihe STORIfS TYNL'CONSTNUCTION
wurk(or which Ni�pcemn is ismed.
FIX'IV RFS-PF.R TRAP
❑ I h:rve nnd will mnimnin Worker'x Cnmpenxminn Li.curonce,as rcynired hy Seaion
3]Wo(J�cl.uborC�We,forthcpcAnnnenceofiheworkfnrwhicM1NispmmiiisissuW. GAS-G.SYSTF.M-IINC.40UTLhTS
MyWorker'sCompemminnlnsueancccartiervndPolicynumM1crurc: OCCGHOUP ppry
Cwrier: Pnlicy Nn.: GA$-9A.SYSTEM-OVLR�IEA)
CERTIFlCATIi OF G%F.MPI'ION FHOM WORKERS
COMPLNSATION INSUHANCF. GRF.ASE/INDUSTNI,WASTIi INTCRCEVfOR
(Thin Mciinn nceJ nm hc conipineJ if ihe pe�mit i.s for nnc hunJre�aollun($IIMp NUILDINO DI VISION FY.IS
ar IcssJ CNHASE TRAV
1 anify ihat in�M1e�nAnrmancc ul�hc wnrk Inr whlch ihix PLANCiI[CK FF.Ii
permi�i.visvucJ,Ish:ill SLWIiN-SANITANY-STOMML'A.2WI�1'.
o�employ nny pe.rson in any munner eo ac iu M1mnme subjem io�he Wnrkerx'n,m��- erir:kcv rr:e �
O2 sa�innl�waofCalifomia.Dam Wq'fLRH[A'fERW/VENT?:LF.CTH
� O Ann����� GNADINCFFF.
y NOPICF'1'�APPLICANT:11;War making ihi.s Ccnilicam ol�aemp�ian,ynu shoulJ WpT13R SYSTLM/1'NGTING
a � becnme subjm io�he Workels Campensaiion pmvisinns of ihe LuMrz CW<,yuu mu.� SOILS FIAi
fonliwiih enmpiy wiih xneM1 prnvisiun.nr this permii nhnil h JuumeJ nvokeJ.
a Q WATfNStiRVICF,
� z CONSTRUCf10N LC:NUING qGENCY NLW RF.SIDIiNT1A1.PLMR SQ.fT. PAIU
(�Q IhereM1yuffnmihnuhemisucnnxweilnnlenJingngencyforibeperfonnunceol ' Neceipia
� F ihe wurk fnr which Niv peemi�is ismW(Sce.JU9].Civ.CJ
0 U LenJclsNamc
I.rntler's AAdmv.� TOTAI.:
IOTAL:
F p,� I cenify�ha�1 have rc:ul ihie epPlicmion and num Nm ihe ab�ve infomiaion is BUILDING FtF. � \
fq cortem.lagrttmmmplywiihullciiyunJ<aun�yarAinuncesxnJsmmlowsmW�in6��� QTY. Mf:CHANICALPERMIT . FFF
V z FuilJingmns�me�inn,endherchyamhnriureprccemmivesolihixciiyioemeru�wnihe SL'ItiMICP[G
� abnve�menunnNpmpenyfurin�peninnpumutts.
(Wyngmemxavc.inJomnifynndkecphamduaviheCityofCupeninnnoin�i PERMITISSUANCii
IiaFili�ies,'ryd �s,cns�sonae.a 6 [LIiCTRICFF.
smen pcnaswhichmayinonywnyaccmeebainv�.uidCiry q�,TT;ftONADDTOMECH.
in ronscquence u(�he geamins of�his pcemii. PW MBING
APPI.ICANTIINI]IiMSTANDSANDWII,I,COMYLYWI'1'IIAI,1,NnN�PO1N1' p�RIIANIII.INGUNIT(TOIO,WIICPM)
SOUNCERGGOLATIONS. MIiCHAMCAL :li
�- ��l �Zv gA NRHpNDI.INGUNIT(OVF,RIU,IXpCFM� �ONSTNOC'f10N X
sis�m ornppecan om m. �� Dam
PXHAUSTf100O�W/pUCT)
HAZAHDOUS MATLRIAI.S(]ISCLOSU0.G HOUSINC.h11TIGATI P[E
WiOilmupplic:miorlumrebuilJingoc<upamnarcurhmidlehwallousmuteriel HF.A'1'INGUNIT(TOIW.qXIHTU)
u dvfined by�he Cupenino Municipal Cotle,Chapmr 9.1?,anJ @e Ncalih and Sa&iy
Codc,Siciion 1553P(u)'7 H13ATING UNIT(OVGR I(Nl,qq IITU)
❑Yc5 ❑Nn
VENTILATIONFAN(SINGLGRESID� PAIU
Will the applicnm or fumre hnilJing necnpem u,ve eynipinem or aevims which Daie Neceip�
cmiihazvanusa'vcnmuminumsasJefinedFyiheNayArtaAirQualilyManagemem BOILIiR-COMP(3HPORIIMI,WfINTU)
Distnc�? TOTAI.:
❑Ycn� ❑No BOILI3R-COMP(OVbRllx4�%M���'llp
I have mad ihe huzmAnus mmmulx requimmrn�e unJerCM1upmr fi.)5 nf�M1e Cali� ��R CONDITIONF:H
fomin fleuhh&tiufeiy Gde,ticciinn..8505,25533 unJ 2553J.1 un�eniand�M1m if Ne ISSUANCE DATC
builJingd¢snolcunenllyhnvcuMnvnLNali�ismym�ryirtsibiliiyionWify�he�mpam NIiWHF_SIDIiMfIqI,MHCH. SQ.PI'.
nf�hc requirtmrn�s which mus�he ma pnur m ixauanm of a Cenitica�c of Occupuncy.
Owner or amhonzN ngeni Dae TOTAL:
ISSULD DY:
OFFICE