28177 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
PERMIT NO.
CITY OF CUPEAI,
SIO NO APP[ [CATION/PERMIT PLUMBING-MECHANICAL n p
BUILDING DIVISION BUILDING PROJECT IDENTIRCAI'ION G O
BUILDING ADDRESS, J/— Jr/ SANITARY NO. AM?LIC, rIONSUBAIHTALDATE
� 1 I v
O UNIT# LOT a
EAS NAME: PHONE: CONTRACTOR'S NAME: LICNO:
y�Wip, NUC CONTROL#
ARCIIITIWCIO ate+
CONTACT: PHONE BUILDING PERMIT INTO
QTY. ELECTRIC PERMIT FEE
BLDG ELECT PLUMB MECII
PtRAf1IISSUANCE ❑ El ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
nwz I hereby offirm that l am Bemused wdmpmvitiaeofChaptn 9(comnearwingwilh JOB DESCRIPTION
a00 section Division 3uflW Bunrcnad Pmlcssiom Gale,and my Have is in PANELS
�+E font raeeweR GH+�lt►6'f 2' R\�
NG[n
2a i
QLiccLc.a UPT0200AMPS
Gane I1Cony
201.1000AMPS
7ONZ ARCIIII'ECPS DECIARA9lON OVER IOW AMPS SQ.FT.FLOOR AREA S/SQ,HT,
O Z—❑ I urNvalmd my plans.h.11 be usedm public retool,
SIGNS ELECTRICAL
[Acetal Tlofeuiaul
K d'< OWNER-BUILDER DECLARATION SPE;CIALCIRCUTDMISC.
I hereby affirm than I am e.mn,from Ibe Contractor's Liana Iaw fa Nc
u140tF<is following reamm.(Seen.7031.5,Businev ad Pmfesdms Cade:Any city or camty TEMP.M OR TOL INST.
H.] which recurs,a carm,la roust.,all,iml+ove,d,mulish,m repair it,structure
�i�5 Pia to its issuance.elmrryuilesthe applicantfmsuch pemdttofile axignednale11eun POWER DEVICES
C O Thal he Is Breus pm,csot to the,provisions milk CoNnKlorx Liana law(Clui
dLX 9l«Inunmc'ily with Sectimi]"Urd'Division Softhe Bu,ian.rd Four.Code) SWIMMING TOOL ELECTRIC VALUATION
W'_9'tn
in runt he is excmpllMefrum and the hasia for the alleged cxemptim.Any violation of
t-KQ 5«tim]0313 by any eppliant faapcnnit,ubjecla do applicrltoecivilpmdry of OUTLETS-SWITCHES-FIXTURES
nal marc Ihim rive hudred doll.($5()U}
K o Cl I,nowntto(Ihepmperry.mmYemplo enwiN wags nthnrsMecam NEW RESIDENTIAL FLECTR _SQ.Fr.
u1 y peradm, STORIES TYPE CONSIRU [ION
p, will duthe wor4,and me she Comanin to intended Law ed dos w apply to an owner ss
auslof
m ,m ed,who ons,
Codc: ilc tttherea s rd.a Law ores not apply to m owner of
popery who tui ids err impmvn chnmt,.d who daa weh wM M1imxlfa Through his
emr.the movi&d OxlsuchimlaovOnentsare n«imcddomffad fawk.IL OCC ROUP RLS.UNITS
builder
will Use
the almpoveciving ou teithin«eyear of cairove for
Ncoaxr- TOTAL:
Wilda will M1ave the bwdcn of proving Nal he did ml Wildaimpmvc OK puOxec of
ale.).
❑ I,wowner u(Ihe pmpeny.amexclusively c«umctingwith lkcnwJ canlmclun In Qom' PLUMBING PERMIT FEE MOOD ZONE, APN
..,the Traject(Sec.]Ola,Business and FYofusier Cade:)The Convxla'.
Liatxc I've docs ted epplym w uwnttof'u'u-Iy win Wilds«improvn Nctam,am! PERMIT ISSUANCE
wMconures f«such pmjcttswilharonvatm(s)Irrnecd Pvsu.ni to De Clmsector" ALTER (PA)
Luno Law. FEE SUMMARY
❑ I ran sx.Tt umkr Sec. ,B&1',C fm Nis firman BACK FLOW PROTECT'.DEVICE OUTS[
SANITARY T N
Owner Dale RF.CF,I IT M
WORKMAN COMPENSATION DECLARATION DRAINS,FLOOR.ROOF.AREA CONT. SCHOOLTAX T N
❑ IM1caby drirm thnlhavicermifwne aft manlmalf-inwm,oracmifcam of RFrTIvra
FIXTURES-PER TRAP
w«kcn'C«nprnntitn lmurerce«.ca4fid copdeaJS00
y rtof(S . ,IaM1 C.)which PARK FEE T N
covers ell empl'e i under this pormil. OAS-EA.SY.STEMd INC.a OUTLETS RFUUMr.
Policy x BUILDING DIVISION FEES
C«npany GAS-EA.SYSTEM OVER a(EA) I11.ANCBECK FEE
Ir Certified«py u hereby fumi.hed.
❑ CrniOcd nysy it Bld with de city inrpectiml division. GRFASEANDUSTRL WASTE INTERCEPTOR GRADING EFL'
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(This sxclion used not becmnpleled iflhe permll is forooe hurdncd doElva(5100) SEWEJR-SANITARY-STORMFA.20(FT. ENERGY IYE
m)nu)
I cenify Nnl in the perfomwceof Ne wait fm which Nu ternil uiswed,I,M1dI WATER 11EATER W/VFNDRLECIR
M empty any penmen in mtY menrcr n m berate subject In Ibe WMerr p
O Z App�a.=,ImlawsMCdiform. Date w WATER SYSTI:AVfREAT1, pale RecnptM
Z 2 NOTICE TO APPLICANT:If,din mating this Cermi re of Fanoplkn,You abouki NEW RES)DENTAL FLAB. SQ.FT.
F V] berate mbjmtothe N'Mer',Cumfeavinatpmvisims of the laWr Code.you must IlTTAh:
faahwiNc with sucM1 pcmli
comply wi pmvidau a Nu t ebdl M detttcd headed BUILDING FF,F
CL Q CONSTRUCTION LENDING AGENCY V SEISMIC IEE
I herby dRFourw
rm Nthem in a cansciion lading agency fur firs,
performance
Nof TOTAL,: ELECTRIC FEE
V O e wak(a which this permit i,is,ved(Sec3097
. ,Civ.C.)
r 1<ndcr.Nunn
OOF Yodels Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE
1 unify[hal I hive read[his application turn!stale most Ihs.Wve inf.moss is
correct I agrwcticcot
hertwith
bal all
wcity
ilnrlurt my ordimnc,,ad mate laws reading It PERMIT ISSUANCE; MECI IANICAL FEE
V1 gct*e' paanutiveofNu city to ewer upon the
U 'Z above-motionill properly for insp¢lion pmry s ALT UR OR ADD TO MECI I. CONSTRUCTION TAX
(we)agree to save.Ldatmiry.rd keep harden the City of Cupcadtn ageiw
Iiabilitic,judgmet costa anduprnacs which may in any wnyecaueagaim't said City AIR I IANDLWG UNIT U 0 F,000 CFM)
ncalxqume the (Ibis pOrmiL
AIR HANDLING UNIT(OVER I0,000 CFM)
SigricimucK( t/C rotor Qua, EXHAUST HOOD(WMUCD
PAID
HA%ARD S ATERIAIS DISCLOSURE HEA'I'INGUNIT(T0100,000BN) Date Rmeipg
m de0ndt 1 taful ding aeclard nae a hadle h=ss.dam rlweriel BEATING UNIT(OVER IOO,OW BTU)
y upend.Municipal Cods.Chopler 9.12,and the HedN and Salllry
Coe,Station ye, (a)? ❑No VE711ATION FAN(SINGLE RFSID) t
WTIl de appliunlafwurt Wiltlingoccupanl ua nryipmem adcvim sublet emit
BITTER-COMP(311P OR 100.000 BTI[) ISSUANCE DATE
Mwdm.air meta nnar.m defined by the Boy Area Air Qudily Maregcnem BOILER-COMP(OVER M."wri-E
pi,uiwl
1:1 Yea ❑No NEW RFSIUEMIAL MECH. SQ,Fr. PAID
I hove red the hamrdnus materials reciuiremOnu under Chapter 6.95 of the JUN 13
California Health&Safety Cods,Section.25505.25533 ad 255 W. I undenlnM that 95
if tic building don nor currently M1uve a Tenant that it is my re.pauibility m notify co,
occup.m of the aultd rnts which run be mel Tnior In i'mooe M e Certifirade of
t>u�y. CITY •fir
rf
Owrcr a autFaiad.genl Dare TOTAL: ISSUED BY: I INU
OFFICE ,�