19992APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE'BALL POINT PEN ONLY
Building Pro d Identification
Bbadbg Add�a:
"Z315oo fie. tie i (S I t z 3 Pas''
PERMIT NO.
1999
re .cors One.
F-610-19" (YQ pV p
CITY OF CUPERT INO-BUILDING DIVISION
APPLICATION I PERMIT
APPUCA
P -2(8/� Q
lam) D CJ I
Contractor'.Nams; - Lic. No:
BUIL.DINGELEC"IAICALPLUMBiNGMECHAMGl
G'[F1',ORY
CONTROL
Archltect/F ghee'.. -F. �+, Llc No 2 1 G 7' 16
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Add—L,�Qq �1 Z7I dI•� r S
PERMITISSUANCE (
❑ ❑ ❑
LICENSED CONTRACTORS DECLARATION
-
' I hereby afMn that l am uomaed under pcovWmuc4chapter 9 (.c,
BusinasandPm/eesionaCade,and
tls�1.
APPUANCESRESIDFMIAL
.y—�j {J/J�B- DESCRIPTION
license ll7rceand effectn3oflhe
PANELS
1 1�-•t Q L-•�� .
Date Class
Dale Contractor
UP TO 200 Ah(E5
.1 AMPS
. ARCHITECTS DECLARATION
luMentatd my phu aheube used as pubilerecbrd..
OVER 1000A.MPS
SQ. Fr. FLOOR AREA
Fr.
SIGNS FLECTRICM, FPI
Lkxrsed Professional
A L E D I.
g•ECIALCIRCUTT/MISC
OWNEBUILDER DECLARATION
Ihertbya0rm that mexempt fmmthe License Law for
l¢roelawf¢tk
M P T E
-
TEMP. METER OR POLE INST.
La����TL
POWER DEVICE' OA
following ressml. (Section 70315, Business and Peofembu Cody. Any city or
ch,orrepdr
mu stywMch rryulanapermne,construct, alter, aprwent for
any structure Prior to lb Issuance, also requlaothe appHanl for such permit to
0b a signed �atement that he Is u¢n.ed purnunt to the pmdelom of the
Seabnherefm and
.,m3 oftheBusins and
ebn3oflhe Budnes and Proresbrocade)brthat he fe exempt therdmmard
Prof ler9(mmmer that he
/R 5�/,a/
7 ;
a�aa�R
SWIMMING IDOL. ELECTRIC
VALUATION .•.
the bub for the alleged exemption. Any dolatlon of Section 7m IS by any
appu¢nt fora permit subject. the applicant to a dWl penalty of not more than
OUTLETSSW[TCI¢SFPlURFS
NEWRFSIDETTIALELECTR SQFT.
flue .an dollars
1, a owner
1ofth. pro
the property, or my ernpbyen with wager their Bole
STORIES
TYPECONSP!UCTION'
will r
mmpeva im,0K Rut dots. nor a f.M. C dura b not Intended or.. Law
sob (Sec 7014, arnos and Code: The Contraoves W¢roe Law
to f property
dm wtapply man owner ofpcoperty who bulkls orimprwnthrmn,and
whodoosuch work Mm HBor aghwownemployeea,pmvdedthatwdi
OCC GROUP
RFS. UNITS
improvemew are cot intended oroffereciforuL. TL however, the W ilding or
Imvam
prueM b aold within oneyearofcompletion, the owner4ru WcrwBl have
TOTAL
,
t oIm.f prwing that he did nm build or improve for purposeofale.).
Lf L as owwr of the property, am excwi¢y contracting with lkxmed
contractors to construct the project &c 700 Business and Profesicu Cade...
QTY. PLUMBING PERMIT FEE
PERMIT ISSUANCE
FLOOD ZONE,
APN
The Contractor'. License Law does rwt appy to an owner of property who
builds or lmpmvon
n there, and who contracts f« such ptojeeb with a
ed pa r.ut to the Contradbr'. LI¢se Law..
Ij➢If.don.)ll¢na.n
IJ I am evempt under Sec B k P C for this mason
ALTQt-DRAIN&VFNI- WATER MA)
- FEE SUMMARY
BAIX FIDWPROTECT. DEVICE
DRAINS FLOOR ROOF, AREA, GOND.
SANITARY Y N
RECEIPT#
Avner Due
WORKMAN COMPENSATION DECLARATION
1-11 hereby affirm that I have • ¢rlNate of consent to self -Insure, «a
¢rtNrab OfWorkeni Comperuatim lwuran¢«a ¢rtl(led copy th<nmf(Sec
3800, Lab CJ
Ff%7f)RES PER TRNr
SCtRpLTAX Y - N_
RECte. Y
S LETS GAEA. SYSTEM -1 INCA OUT
PARK Y FEE N
PolCo Y
TY
GAS EA. SYSEh(-OVER
y
DING DIVISION
BUILDING DI VL510NFEFS
T
'—' "`Neo miry b filedhereturNehM.
CertNed copy b Illed'with the city Iwpec[bn didsion.
GREASE/INDUSIRI. WASTE INTFxLEPTOR
PLANCHECK FEE
GREASE TRAP
CERTIFIGTB OF UtIMPEON FROM WORKERS
COMPENSATION INSURANCE
fl
need rad kcompld<d tithe permit b/«ona hundred dollarsmm)«lema
PAID
Date Recel tit
sFwEB-SANITARYSIORM FA. wo
WATER HEATERW/VENT/EDC'M
ENERGY FEE Y N—
PAID
or ledlon
hat In
he so as to become
permit ct to the
I nor employ any person
1 shell rat employ any person In any manner m u to become subject to the
In ny manner
nv
Competlon Iawxof California.alifor. Date
e
-
WATER SYSITM/TREATING
,tppucaont
Applicant
sgTICE APPLICANT: .Russ making this
Date Revel Hf
NEW RESIDFNIUI. PLMB.SQFT.
TOTAL:
co me b�cd to a .tion pm da mt of a Labor
Labbe
Wonken' Compensation provhis
Cocfe,shoulyou =at
Cade, you neat forthwith comply with ouch pmvbbw orthb permit "I be
per it
dmmed ravokM.
BUILDING FEE
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
Ihembyaf. that there b a construction NMingagencyfbrtheperfomF
ane of the work for which this permit is Issued (Sec 3091, Clv. C.)
TOTAL
ELECTRIC FEE
0
Lendek
PLUMBING FEE
ser dA ems.
I¢rtlA dgrehavereadtwapplket mandi.ndcotate t.odi,mocs a dstateetlm
bcoingtLagneetg comply whh andhrb muhcx1ce Nanomand state
QTY. MECHANICAL PERMIT FEE
-
MECHANICAL FEE
PERMTT6NANCE
FEE$PAID:
Wildingmnabumon, and hereby author reptiontativnofthb
chyto enter
cityWenterupon theabbvcmentbwd property f«Iwpe Cit patrposea
I
(We) agree m...2, WemMy an a keep natMem the ary of Cu pen
ALTER ORADDTOMECH.
,
Date Remi t»
SUBTOTAL:
against Habluttes, iudgments,costs a rd experun which may In any way amue
aga but said City to consequence of the granting d this permit.
-
AIR HANDLING UNIT (TO 10,000 CFM)
AIR HANDUNG UNIT (OVER IO,ODOCFM)
CONSTRUCTION TAX ,
Slgnatureof Appliam/Contract¢ Date
EliBAUSr HOOD (w/DUCD
CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DI SCIASURE
HEATING UNIT (10 1 OD,000 BTJ)
Will the appllaM«future Wilding occupant more or handle harardoes
mourbl as dmrcd by the C.pert. MunldpaI Cade, Chapter 9.1 7, and the
HealthaM Safety Code Section 75537W7 -
�4 Yn�
W(ha harani use tuntandoang bavpant use thego, ria dcvim
which eMtagermt abconbmW Meas defined by the Bay Arra Air
Date Revel tJf
HEATING UNIT 100,000 RTU)
� TOTAL:
b�O
VENTILATION FAN (SINGLE RFSID)
ISSUANCE DATE.
BOR.ER-COMP DEB'OR IIXI,IXq BTU)
IHy Management D'rtAct7
Yes I� No
N
BDB OOMP(OVER 100,000 BTI))
haver<ad the havrdoui rmaterlab requbemenb under Chaper6.95 of
the GIH«nla HeAh & SafetyCade, Sectbro 5505, 5533 and 255x. I
NEW RESIDENTIAL MUCK SQ.FT.
uMerstand that if the Wilding don not currently have. tenant, that it b my
raponalblldy to notify the occvpaM of Ne requlrerrcnis whRh rnuat be nrt
•r
APR Z IJ.7L/ .
/� 1 0
P..tolaou.nceof.Ccrtifbteo! Pa
Uvner or suthorl xxl ag Dab
1 1
i55UGD
TOTAL
BY:
OFFICE COPY