S 0297 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPE RTINO BUILDING-F•LECI'RICAL PERIOD NO,
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL S O 2 Q 7
IIOIIAING PROJECT 108 N1'IEICATHINnsll
BUILDING ADDRESS: D6O A'P�q SANITARY N(1. APPLICATION SUIIMITIAI,DATE
OWNERS NAME: n H(yJ„�� l C(l R�•r(jR'h ���{ 1 D4.
/['1 O/MSS S {L• H`/�' b 4{ WC CONIROLN
ARCH I ECI'IBNGIN ITER: LIC No 7776 iir-,yAj� r s� ❑
CONTACT: PHONE. // /V ES' BUILDING PERMI1 INFO
❑ Consultant Ftes Paid by Applicant(Initial) BLDG ELECT' PLUMB B:CI
❑ ❑ ❑
LICENSE[)CON'I'RAM OPUS DF.CLANAIION QTY ELECTRICPERMIT FEE
I hereby of ind mat 1 am licensed under provisions of chapter 9(commencing JOB DESCRIPTION
°aZ with Section 9100).&Dlvixion Jof thaBminn%und Profcsxinn.Codaand all llcenseix RESIDENTIAL;
O PERMIT ISSUANCE
�W� in
ill]ltoostuJclleor_ O 11 ❑SPDN'L ❑KITCHEN RCp10DEl.
aVV LittnseClass ffrr Lich T APPLIANCES-RBSTPEN I[A). ❑ADDITION ❑PLUMBING RE PIPE
yzU Dam cernma"r
❑y ARCHITECTS DECLAR ION PANIi1S ❑MULTI-UNIT El STRUCTURAL
MODIFICATION
Z p m�. I understand my plane shall he u,aJ a,.public recnsln -
°Z•° UPI 021XIAMPS ❑INTERIOR C)CHlALN1iY REPAIR
F�2LM Licence Plofnsinnal 201-1100AMPS IMPROVEMENT E]SWIMM INC,FOOLS
a E� OWNER-BUILDER DECLARATION
¢� , OVER I(X0AAIRS ❑BA'TB RI NOD '�A0111O�D/IiM�OLI�TIO��\f—
C a I hcmby.Sfifiall Ill.,I am hemp from Ilse Contrvam'x License Law fur me
i°u:V ❑UI'l1ER
X 3 d whfollich
requires a Permit
it 70.1 sty Bsinn%uod improve.
dem li Codc:Any city m ummY SIGNS ELIiC&RICAI.
xbich rcquirtx issuance.also re commie,alter,improve,h colut ti or repair any nruarm
t_ °a
prior.slicents ahortquime mus inioieltcant he sucConractor ereannete a Law ued
SPIiCInI.CINCUIT/MISE.
W,1 7 That he is liccr.%ul punuunnn me prnvianm of lM1u c.mmnors hi«mc Luw(Chup¢r9
WCaf' Innnmencing with Secction 7000)of Division 3 of the Business and Pmfensions Gde)or TEMP.METFER OR POLE INSII COMMERCIAL
:
W_pO
a.y o C 'hot he is moculd Ihemfimn lord the base fur the allr,rd excmpinn.Ary viol aina , ❑NEW BLDGIAOUI'I'ION ❑DfiAfOl.l'I'ION
til w Secounl031.5 byany.pplicant for.pcorra subjects lbcapplaar m ilsivil pe.aRyof POWER DEVICES [I TENANT [I FOOD SERVICE
not mum than five h uldtwl dollars(S510r IMPROVEMENT
I] 1,.—varrof the Implicitly,or my umpnyees will]wage%an Inch sole nmtgenration, SWIMMI NO POOL ELECTS IC
W will Jo the wark,aM the suraum is nm s Lwrad or ofwdoesor,al a,],to an.Ifuninn% ❑OTHER
3 w nnJ Prty who b Care r iFhamp Cosohereo Llcuroc Lew does not apply s if rosea of 01J'rL6'IS-SWI'rCfIEs-FI%'TURES
progeny Phu bu11Jx or impmvn them.,and who re, such rind bed,or through
his awn nsploycn,pnrvideJ mat such nOcn, oldv are not intended..oRun•J fur NEW RESIDENTIAL GLECI'R SQ I%'.
nal>11:however.the ha(l)ing orimpmvcmuni%aAJ within ons y.,,.fa tmpetinn,he Q.A FJOD AREA 5/SQFr.
•r-luilder will have the burden of proving that he did not build or improve for put,��cofnalr.) FEB �8
❑ 1.as...sa said the progeny,um eedrsively contrnning with licensd mimmc.rs m 'IOTA I. .1,_
instruct the project(See.7614.Business and Prof sionn C(BC:)The Commcnnl Li-
corm Law does not apply to on owner of propcny who builds or improves thereon.and QTY. PLUMB ING PERMIT CI
who contracts for such projects with a comoutorO)licenwl Pursuant m the Contractors UI- LLI
L"'a'a La, PERMIT ISSUANCE -Ll]I III'U
❑I am exemp under Sec. .B h P C ha this mason
ACI'GR-GRAIN A VENT'-WATER 11W VALUATION
Owner UIO
WORKER'S COMPENSATION pefATION DECLARATION BACK FLOW PS(JI'ECT.DEVICE
hereby affirm under penalty ne ofCon one o thewif Iollmwin r Woker declarations
Ibave and will maintain aCenificam aCnnwnuo¢If-insure for Workers Cnmpen- DRAINS-BOOR,ROOF AREA,GOND. STORIES TYPE C(INSTRUCfION
nation,as provided for by Section 3700 of the Labor Code.for Ibe ryufonnance of the
work fur which this panni,is issued FIXTURES-PER TRAP
have and will radearn Wnrker'e Compensation Insurance,an calcified
by Section
-7 of the lybor Care.or the perfummnce at the work Ga which this permit is issued. GAS-6A.SYSTIIM-I INC.40UTLETS OCG GROUP N'N
My Work "Com nsationln nee��a�ajja���'erunit Pulley'n{�umbe
C:nFiat
� C:RTII'ICAT: F'EX6Atl'IION yf ROATWOR l: 5' f\S-E\.SYSI'IiMOVIiRJ1EA1
COMPENSATION INSURANCE GRIiASFIINDUSTRL WASTE INTF,RCGPr(IR BUILDING DIVISION PEES
Tlbe,c,ion hoadntit lwcnmplood it the pemtit is forms,hundred dollars lS lO GRL'ASF-TRAP
or le%s.) 1'LANCHECK PGE
I cerify that in @e perferm:mceter the walk ler whic1 hi,aarmi,,issued,I.hall SEWER-SANITARY-STORM EA.200 FI'.
not employ any person to any mmoner nm as m become subject to IM1e worAeri Compen- ENERGY FE[
Z 'anon Laws of California.Date WAI 17R HEATER WNHN'I/If,FC'IR
Z E
NOTI
N(TfICE TO ct ,,,he W..k IL char making This Canons of of Exemption,you u loulJ WATER SYSTEM/I'SEArING
a ? hcnmmanbjcclut the Wnrh in Co...... is smuni hal of(IlarCakesyou reap, SOILS ITE
� 4mhwnh comply with such pnrvisinns onhis permil.hall he Jccmcd rcvotrd. WATER SIiHVICE
0
U Z CONS
atthe roueION
construction lending
NEW RESIDF.N'1'IAL PLMB. SQ,ET. PAID Date Rereipt#
U work
which
that i ixa mnsuac.i3097.Cing agcnry for prformuncc of
me work fur which role pemut rx iex.J(Sec.3(197.Civ.C.)
U
Lenders Name Trn'AI.:L) Lcndcr%Addrtsx T(JI'AI,
BUILDING FEE
y 1 cenee That I have read thinapplicationad
y o state That me above..certain,is
F' Z cmnea,,ase,.comply Pim ellnd....dcounryoldirunaes cal lawsmininsm QTY. MECHANICAL PERMIT FEF,
L) Z huilAi.g rr mlructinn.mrUM1cn�hy umhmirc mprc cnuuivesnl'thi%citymcnterneonlM1e SEISMIC FEE
above-mentioned pmleny for in sec)en protestant. PERMIT ISSUANCE
(We)Ura,m nn a.mdenmify and keep humdus,the City of Cupaninn again, ELECTRIC ITE
II.militias.judgment,,coslsmdexpanuxwhich mayinany way acreal. oin.t said City ALTER OR ADD TO MECT1
in consequence of the granting of this permit. PLUMBING IEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N -POI T AIR HANDLING UNIT CTO 10.001 CPAP
MECHANICALITE
SOUR :REGULATIONS.
AIH HANDLING UNIT LOVES IOIXIII CPMI CONS'I'RUCI'ION TAX
Sign AFprcanUContraanr P L%IIAUST HOOD OAMUCT) IIOUSINGMITIGAI'ION PEE
HAZARDOUS MATERIALS 1 :CLOSURE
Will the applicant or future building neari,pildsome.r handle hmallou,..,trial HEATING UNIT(TO I00L000 BTU)
its dufned by the Cupeniso Municipal Call,Chapter 912,and the Health and Safely
Cuda.Section 15532(a)'I HEATING UNIT(OVER 100.000 B TU)
�Yn PAID
N
VEN'I'ILA'I'[ON FAS I NGLE R ESID) Date Receipt#
Will,he applicant or future building occupant use equipment or devices which
a it he...Yet
dnnx nor coal;mues as JuOeed by the[to,Atw Air Quality Management BOILER-COMP 13HP OR 100,6X0 B'I'U)
TOTAL:
Duane," _ / BOILER-COMP(OVER 100.000 BTU)
❑ [�Q
I have real haaminm.
ox cdols require
I,under Chapter 6.95 of the Is
AIH CONDITIONER ISSUANCE LATE
fnmiu Health&Solely Gale.SecOo.s 255115,25533 and 25534.1 understand that it the NEW RESIDENTIAL MECH. SQ.ET.
nuiding . rrtinyne , al it is ter rc,p"n.ibditymnotify ma wr
ulvm
"&merenerxmBom
TOTAL
Ow n
agvnl ISSUED BY:
OFFICE