28162 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
1 .- A,1C'ERICA. I'IiNkI1T No
28162 w ata
CITY OF CUPF,SION PLUMIIING-MF,CFI RICAL •2 l8 L
Ruu.DINc nrvlsum APPLICATION/PERMIT
bq u r r
BUILDING ROIKCT I06N'TIPIC TON
BUILDING ADDRESS: D _' SANITARY NO. APPIACAIION S111MITIALDA'IE
AA394 �ci EST/No 4*10 UNIT. /ice LOT C.
WNERSNAMF: PHONE: COM RAO OR:S NAME: / - IAC NO: NA: (.ONIROLX
'u uEw 2 - 3 0 n AJ .I./EA/ ( 0.•gs r, 2-32 26
AT
RCHITECTQINGINEER: IC NO i ADDRESS: ❑
CONTACT: PRONE: `�-F d'•' +"a' t I HUILDINO PERMIT INFO
Q'f�'. - ., BLICI'RIC PP�tIy1PP ' ` 8
� •,BLI Loa.—F�cr I.9sI-IMOD MliCil
I(LL L,(,[..xsgb�(( y53—d/3cr PMMITISSUANCH. �/ Tslb Tp 0
LICENSED CONTRACTOR'S DCCLARAI'ION APPLIANCES.RMIDENTIN, JOB DISC'RIVI ION
GCZ Iherehy ofDiihmF 3 rs of the
edurder R.,imsmdPsinsioCCade,.d.1license will, /g _-t
1100 Sechon7000)e.ndef Division3mf the Bminess sots i'mksainm Cade,end.1 license is in PANELS gg.IJ•rO1�'f-•T,
C
full fume aid efface' UP TO 2011 AMPS
FZW Date Clnsa Ling
y=y Dae Contracux 201-IIXIU AMPS - SQ.PI'.Ji`X)R AREA S/SQ.I'r.
ZF•H? ARCIIIT F.C-S DECLARATION OVER ITIM AMTS
CC q 1 undecomd my pinns shall he osaN es Ivhlie mcvrda.
FNIqWW SIGNS ELECTRICAL
'] Licensed Prokuinnel -..
y�QQ OWNER-BUILDER DECLARATION gPECIAI.CIRCUIT/MISC.
�g0.�S4OyU 1 hcrchy 01not the 1 am esemp ren the Coo.ne.✓s License law for tht, /
N13ay¢ fallowing motto Section 70.11.5,Business and Professions Code:Any city m counly TfiMP.MEIT:R OR p)LE INSI'.
tLLwJ whicho,aims o Permit to construct,after improve.demolish.or repair any structure
E YE psi.Ooiuissu.nor,al.celpims the spplicam f-mch pemitto filesaig ed statement POWER DEVICES
<O Lhar he is licensed pat........he p.visins mf the Contractors License Law(Chapter
O SWIMMING POOL ELECTRIC VALUATION
6OL4 9(commencing with Section 70M)of Division S of the Business and Profeni.rs Code)
jay orthat be is exesnpthecbmn and be basin for the alleged exemption.Any viola.in.of �CJ
OUILEES-SWITCHES-FIXTURES �ac aC!l
Y Section 10315 by my applicant for a pvmi.subjects the epplinnno.civil penalty of x'•
mu more ohan five hondnod d.11am 350111. st
NEW RMiDENT1ALIA.EcTR _SQ.PI'. ,TORUS l'YI'li C(IN.INIIC-ZION
❑ L.mwneroOhcpopeny,.rmyemploycenwith wagean Umir solecounpns0.i-t
will dmfsw-k.Code;Th Comismx in.adese La does
to
whereof
and property
whirs Cade:The Cuonmctors License Lew dna nm apply tu an owner of
propertyw,tees, ovidedpmvnthnmmendwhodoessuchw-klot.frned0o'.1a.If.
FICC.G0.0 I' RS.UNIIS
wonemplogees,lding cdmposuchimp.mid within
for sole.IL
however,the have
the
N impmvemcm is cold within ore yam of annotation,the owner- ��
builder will have the M1urJco of pOving that he did nI build m improve!m puq.n¢of
sale) (>
.. .,;,••�'. -„:,' # N� l: a VU ZONi APN
❑ 1,as ownernf.he properly,amesclusively contracting with licensed contraclnnto Y' 'i.,'.:r•• •.. firag're.,�'.�t BL^`
o..towt the project(See 1014,Dain--end Pmfesins Cash:) Bra Cmnncmra PERMIT ISSUANCE
License law does not popery apply to an owner of who builds or improves lhenent.mJ
who contracts For such M*ls with acomrachx(s)licensed Postcard mOx Contractors
Liceme Law. ALTER-DRAIN&VONT-WAT[R(OA) -.4,..d i s+ FEE SUMMARY
❑ 1 oto escmp under S¢, ,B&P C for This cam. E MOT
BACK FLOW PROTECT.DEVICE O )
SANITARY Y N_
ser DaleRECEIPT g
w WORK MAN COMPENSATION DECLARATION DRAINS-FLOOR,R(IOF.AREA,COND. SCIIOOLI'AX Y_N_
❑ I hereby affirm that i have Is certificate ofemmnTlo self-Inure.or a caifocale of FIXTURES-PER TRAPRECEIPT•
Wmkeri Compensation lnesoncema cmifedcolry doeof(Sco.39M,Lab C.)which leg PARK FEC Y__N
eoverstifenplo,ce',mmderthiapermll. GAS-EA.SYSTEM-1IT
INC.40LETS RDIVISrg
Pnlivy M BUILDING OIVISI IIJS
Company GAS.EA.SYSTEM-OVCR 4(EA) PLANCDECK FEE
❑ Certified copy is hcrchy tarnished.
❑ Cmifed copy is fled with the city Impaction divisions. GRFASIONDUSTRI.WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASGTRAP SOILS M
COMPENSATION INSURANCE
(This section need nnr heconplcted lfthe permit is fm ese hundred dollars(SIM) SEWER-SANITARY-STORM EA.2001T. ENMIYIEE
less.)
I certify that in the Performance afthew-k fm which this permit is issued.I&hall WATER HEATER WNCN r/ELECFR
an, employ any person in any runner,m es m he.suhjccl m the Wmkeri PAID
Onnpnmtiom L.ws col CnlifOmin. ban WATER SYSTf:MrrREAT ING U Receipt
00 Applicant
zQ NOTICE TO APPLICANT:ILeRcr making this Cerlinc.enf Campion,you should NEW RESIDENTIAL PLMB. SQ.IT. TOTAL:
F+ fq becnamhjecno.he Worker s Compensation pmvisinn.fthe Lehr Code,you roan
fnrlhwi.nc0mply with such prnskins-t his peen shall he deemed mv.ked. BIT m. r4
Q CONSTRUM ION LENDING AGENCY SlIssuC
tu
z T hereby affirm that them is a construction le-ling egncy for the Performance of O P.LECIRIC FEE
O the wmk fm old,Is his permit h ismed(Scc.30'sO.Civ.C.) . .
Larule'a Nomc
O lender's Address QTY. AIHCIIANICAL PPIPMIT -�s PBH;r PLUMBING IIiF
Ila I certify the.I have read this applian.and usle that the above infom.atin in MCCIIANICAL •E
a cartes,lugree to comply with all city am caumy mdimnemodstant Iowa ml.ingtu IERMI'T ISSUANCE:
ply building conch uc.inn.and hereby sermon representatives of this city m enter Upon the CONS77TUCfl NTAX
V drove-memi0ned po.crly for inspection purposes. ALTER OR ADO TO MECII.
(Wel.green save,indemnify and keep harmless the CII,of C.Penimo It t
liehililies,judgmama.cooleldc.pc .which mayirany way accmeegain.said City AIR HANDLING UNIT(To I(I,gS CFM)
in consequence of the granting of.hls permit
AIR IIANDLING UNIT(OVER 10,(1(gl CEM)
Signature of A,,I;, M(bmsrnn Dam EST At IS r I IOOD(W/DUCO PAID
HAZARDOUS MAT ERIAI S DISCLOSURE: IIIiATING UNOrcro unish1 BTU) Data Rmcip 0
W ill the applicnm ar future building o.cupent same m handle hemmbus..lied gO'pq
as dafnd by.beC.Peninm Municipal Code,Chapter 9.12,and the Health and Safety HEATING ON IT(OVER I IXL000 BTU)
Cole.Sevin 25532607 VENTILATION FAN(SINGLE RPSID)
❑Yea No ISSUANC AjC
Will to applicant or future hmilding occupant usecqulpment m device which moil HOTTER COMP p11FQR 100,IKK1 nTG)
bmerdoua air contaminants as denned by the Day Area Air Quality Mamgemem BOILER-COMP(OVER I010,000 BT U)
Distric1lJUN 15 1995
❑Yea �No NEW RESIDENTIAL MECII. SQ,FI-.
1 have reed.he harard.us materials requirements under Chapter 6.95 of the CI I YIJC
California Death&Softy Code,Sca.ins 25505,25535 end 25534. 1 wds
eland nor ®H I INO
1f the building does nr currently have a tenant that it is my.espmsihility to notify the
mctcpani of the q s who met ruts pi-m issuance o e Ccnifc.a of
M,rpm
Owner or nth ¢. eRcnt Date) T 1 ISSUED BY:
OFFICE