27178 AYYLIUAR I 1 V rILL In mrVnmAl lVn NNll all\acv LmcD-vOc ono rvu.l ren vola
CITY OF CUI'EBUILDING- .,.I. CA. I'IiRMI1NO.
BUILDING DIVISION1. ���� �
IO N NO APPLICATION/PERMIT PLUMPING-MECHANICAL
- ;kg7seBUILDING PROJECTIDENTIMCATION ;h4 .
OIIILDING`ADDRESS: /� SANHARI'NO. APFLICKHON SORM111'At,
/DAIE
�OS_ Jpeq AfLA- UNPIN LOT# /v /
GWNIi S NAME: PIIONIi: �'7- C0 '1 RACfOH'S NAME LIC NO: /V
a.aqr1, 9JiLU NIC CONIKOLN
HCIII I I: -Al f:V n 1.1(:NO: 1 AIDRESS//�� 6� rs� / ''� ❑
..,�� UNI Ell '.�,II// 'a n1oNCL: rd M� .n. : 11:1_.. : F//) sass r.J'J, ., Y
"HLECTRIC PHRMIT'r,r' + PEE BUILDING PERMIT INFO
Q19: ;"�'•iea-..[.. .t•ri ,t - BLDG ELECT PLUMB MECH
AwR 9rt-CzJ PERMIT ISSUANCE 0 0 K ❑
LICENSI! N TRAM ORS DECIARA'T ION APPLIANCES-RESIDENTIAL
mwY Ihechyaffinn that l ten licemeJnnJc poovm ixof Chpt
aer 9(commencing with
101{IIESC.RII'I'ION
POO Semon 7NXuof Divieinn 3nf the nmiroe and Profusions Ode.andmY license is in PANELS
°CULL full force.ndeffcd. UPT02(p AMPS
Fm 6ZW hiccnclass Lie.N
`o<. Use Grnmam NII-IOIO AMPS S .Irl'.PIJK)N AREA 3/SV�19'.
F-,z ARf.III if;C fS DCCLARAl1ON OVER In1U AMT'S V
DO,- 1 umknaml my plana Mall he used or public rcemds,
F yC,W,I SIGNS ELECTRICAL
xseQySJ Limmed Professional
K:=W C OWNHR-BUILDER DECIARA'I ION SPECIAL CIRCUTI/MISC.
yO W V I hetcby arfhm list 1 am esrnlpl from the C'ontractor's I.icenae I,w for the
W' "Vs following reasons(Scotion 11915,Business and l'mkssions Carlo Any city as cot ly TEMP.METER OR PULE INST.
tLL0n which re9Virea a permit m c:nl truct,alter,improve,demnlixh,or mpamr any structure
prior In its issuance.dm requires the applicant for such permit to ll—rignedrlelroml POWER DEVICES
W Wp0 not he is l immed pursuant it)flue provisions of the Contractors License Law(CT.pmr
a�d�((MyIL' 9(conhmcncing with Section 7000)of Division J allhe Buxinoa and PYorearions Code) SWIMMING PLI ELECT RIC VALUAI'IUN
y)_N or that he is axemp0hembmn and the basis fm me alleged esemplion.Anyriolalinn of OUTLET'S-SWITCHES-FIXTURES
tZY Steins 703 1.5 by anynpplicanl lura Toenail subjects the applicant to a civil penalty of
oQ al more than Five hand"dollars 13501.
x; ❑ I.asowreroltheproleriy,mmyemplomswilhwagnulheinolemmMnxalion, NEWRESIDENON.BLECIR _SQ.IT. STORIES TYPIi CONS I RUCIRIN
m3:-2 will do the work.and lbenmcmm is not inlendedor affr N for sale(Sm.70al Business
and Pndeeaionx Cala The Contractor's License Law dive,hot apply to an owner of
pngm,ly who buildsmirnProvenhereoo,and whodn.sach work bimxlfor through his OCG GRUMP RLS.11N1'IS
rgJm
oy ,provide l fled or lse
,imisnormen ¢nal imendeA oroffered Tarsale.It,
honwever ,the building or improvement 4 sold within oneyear ofmmplcliun,the owner- TOTAL:
builder will have the burden of proving that he did act build or improve for purpose of
p Ila,owner of lenpeny.ameacrosind tr.cla mEcenxd aonlmetnrao Y. 'PLUMBING PERMITa� 'Pi p °FEE''' 11.000 ZONE AM
ren contracting �. 7:'e';,9•., ,.'KS;�,"sf;. 1,-
I,msimcl lie noject(Sec.IIWI,Buaineu and RnfoaxiomarCwle:)The,Cnntrecmr'n v
imnx Lawd«armupplyman nwnmofprnperty wFnbuildxaimpmrcx mcrmn,ane PERMIT ISSUANCE 3
whormuractx fmsuch pro*a with aamtracmls)licensed pamuam urthe Contractor s
l.iaenac Low. ALIRR-DRAIN R VEN T.WATER(EA) I'uFEE SUMMARY
❑ I non exempt muRr Sec. _,B k 11 C Por this reamrn FLOW 00-1-9 ID-IEE
BACK ,OW PHfYI'CQ'.DEVICEESANITARY YN
owner Dale DRAINS-FLOOR,ROOF,ARBA.COND. RECEIPI'N
WORKMAN COMPF.NSA'UON DECLARA TITIN SCHOOL TAX Y N
_❑ Iherebynffrmlhatlhave.ceriiricateo(crosenfined4insure,oracertiGnteof FIXTURES-PERTRAP RECEIPT
Waken Compensation Insonate or a cnnifed copy lhsreof(Sco.MIND.Lab C.)which PARK FEE Y N
- - rx all employttiunder this pcnnil. GAS-FA.SYS'IEM"I INCA OUTLETS
RECEIPT'4
Policy# BUILDING DIVISION IRiES
Company GAS-EA.SYST CM"OVFR J(CA) PLANCIIECK FEE
❑ Cenired espy is hereby furnished.
❑ CinilieJ ropy is BleJ wins me city insptation Aivixion. GRHASMNDUS'I RI.WAS 117 INTERCEPTOR GRADING FEE
CER'I'119CA'11701;EXEMPT'ION FROM WORKERS' GREASE T RAP SOIISFEFF
COMPENSA"TION INSURANCE
(Ibis scoionamdnot hosompleted iflhe permit is Tann,hundred dollm(SI(i SEWER-SANITARY-STORM F.A.21)BFT. ENERGY FCC
less)
I cotifydon in the NtImtuom ofine it for which phi:permit i.' .I shall / WATER I IFATFR W/VEFO'pI.ECTR
NA employ any person in any manner
se mmas to fee xuhjal u I often PAID
Cmn,roadion Laws of California. UateWA'LER SYSTEM(TREA TING Dae Receipt
p Z Appucem
Z O NotICH 10 APPLICANT:IC after making his Cenifcahe of a Iplion,Y h J NEW RESIDENTIAL PLMI{. SQ.1T. TOTAL
ret leahr«xhmjeet to rhe worker.cnmlenxa«prnni,mn.a tical((. a1
� ' fonlrvitb comply wins web pmvionnamthix le or dull dem////ad''r��cypl2tLu BUILDING 19;1:
CONS 1'R IJCIIUN I,ENDI I�NC�CC SEISMIC ITEC
� Z nmreby affirm that its cnmtruction nidi eno'k, pormorni eor
V O the wad for which this leonit is issued(Seo.3NG.Civ.C.) "TOTAL: ELECTRIC FEE
Leader,Name - ' R•,
fealer'x Addrexx Q79. Y rj:y,,1 MECIIANICAL`PE01f'P.,U,i. FEE'l PLUMBING PEE
V I comity that 1 have read this apprclumn and sae that the glove information is '• .-i. a v
7" 6. correct.Ice mcum I with all cit idumm rdinenco Knit ante laws relining m I`RRMIT ISSUANCE MECIIANICALFFE
agree pywi city yo g ,
En hui tiling mnarud inn.and badl authorize repmanuhi.a of thix city In color Mate the CONS'fRUCIION T'AX
U z alba,ncminned property far inspection purpose.. ALTER OR ADD 10 MECII.
(We)agree to save,indiction ify and keep harmless the City of Cupcni no egaiosl
liabi lilies.judgmenh,ensu and.penes which may in any way attune against said City AIR DANDLING UN I'I'(1010,0001 CFM)
to come, of the panlit'of suis permit.
/O._' I,_Q AIR I IANDLING UND(OVER 10.000 CFM)
puttee nl ApplicanVCanlm a Uae / EXHAUSTDOOD(WNUCT) PAID
la]ARtureb MAI'GRIAI9Dume or handle
IIHA'IINGUNIT(TO ININIOBTU) Date Receipt
Will the tic iemh oo furore i,i,.]C oacopa t store or hnalle hln;.Ilh material
m JclinrA by tic Cupeninn Municipal Gde.CTnpmr 9.12.mid the llr.JtM1 and Safety IIIiAIIN(i UNIT(OVIiH 1(061X)Bl U) '1111 Al.:
Cala Sachin 15512001
❑Yet ❑No VENT ILA'IION FAN(SINGLE RFSID)
BOILER-COMP t3HP OR 11X1.00)BI Of I��'JS'E DA 11:
will air onstiontmmmrc defined
byoccupanthRay equipment unlit M.nalicamch em /V n
Dikki oro air amuminnma as de(ned by Labe Pry Area Air Quality Mmagement BOILER-COMP(OVER IroJN)IT I'U) �T)
Uiaridi
❑Yo ❑No NEW RFSIDIiMIAL MECII. 51)FT.
I have mad the lonudom ma trials raluimh«ntx under Chapter 695 of the 'CIrY OF J
C.Efnmia Deahh A Safety Ode.Secnonx 25505.25533 and 25534. I uadcrnand 1ha 01101 InUpurlIVO
if rim buil ding d«x ten alnemly tin,c.tenant,that is soy FesPnrdbi0ty u,nulfy the V) J P. v
atpnnn f me re incnu which must Fe met prior m issnalce of a Certificate of / �"�
is
Owific,orratiflicired agent Date Vy TOTAL: ISSUED BY:
OFFICE