26693APPLICANT TO FILL IN INFORMATION WITHIN RED LINES • USE BALL POINT PEN ONLY
�LD>,T g�R1IT ,
CITY OF CUPE
SIONO APPLICATION/PERMIT PLUMBING - MECHANICANfL.
BUILDING DIVLION BUILDING PROJECT IDEIFICATJON
PEEHTNO. 26693
BUILDING ADDRESS:
SANITARY NO.
APTIJCAII(Nl SUBMO'1'Ah DATE
1 //�� �p n�,
SS1
C] Asz � '+ NIT# LOT
_
O SNAM[PHONE LeAc_yZ
RCIII 1!CIfIiNGINPJJi. LLCM
CONTRACTOR'S NAME LIC NO: �I�
"
AfDfJiJ 1RE
W V ^ �J O.�
NTC
❑
CONIAOL♦
Co j�wal � f1—, I� OL Z S -7 /,)) D
S�
G�
QTY. ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
BL - PLUMB MECH
;2
PERMIT ISSUANCE -
�00
S,dE
1QLpI
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0002 L' 0
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LICENSED CONTRACTOR'S DECLARATION
I teeby.Trm tJW I en limvcdmdaprovinovofClupa9 (coruoatanlaiW
Secoot7000).fDivi.ion3orrlr Bvinw and llorea.ioru Code, ud my liceme u in
mu rmoe and! errca
Li. Cln. Lie,.#
mo, Cmhector
APPLIANCES- RJESIDEN
JOB DESCRIPTION
,.�/ �
•�v
PANELS
UP TO 200 AMPS
X11 - 1000 AMPS
ARCIIITE,CTS DECLARATION
I un&..d my pWs.h.11 be vd u Public rtcade
VFA IOOO AMPg
A �
SQ, IT. FLOOR AREA
r
S,SQ. Ief.
SIG 3-PJ.F.CIRICAL —' (I u
Ketone
OWNFJt-BUILDER DECLARATION
1 len," slon doI .n, eaanpt from the Contmctal. Lie., Law f« the
following rcasm.(Sectionl 7031.5, Busimm" Poefcuions Gde: Any city«cmnty
which nNuims a pcmdt to mnstrum alta, Imlnove, JemoliW, a oTtut.ny amxmrt
rnarto its neo.roe,.lso mquim the applicvu for inch permit to fileavgtd.tuvrcnt
duo k is liceved puw.a m the poviuoru of the Contrecbra Live Lev (C3apc
9(mnutcaine with Swim701()ofavision 3 ofthc Busitm mood «v Code)
m that he is exempttherefrom oM the huis for We dlege exemptbn. Any violation of
Section lOJ Ly M1y any oPpliwnt f«nPmnit subjects We epPlimnt loecivil penalty of
SPE IAL CIRCUR/MISC., 1'�'
TEM. OR FOLE MST.
POWER
-
SWIMMING POOL ELECTRIC
VALU�9j]�p�T
J
OIIfLE1S-SWITCHES-FIX'IVRES
O
rot mae then Five M1.dted GAlen(S500).
❑ I,uowmoftic propcny,«myemproyen wlW w.gnuWe'vwkmmpvtudon.
NEW RESIDFNItAL ELECLR SQ. FT.
RIES
TYPECONSTRUCIION
dothcwork,ede urvctocu."Liceinse Rertdf. ak(Ss.]Oa4,Buircof
ed Rnfes.iav Code: The C.wctm's Limit U. don rot .,ply lf v, owner
pmPmy wlo IniJd. «imin^ra tl.etem, arta ohod. emn w«k him,.«Wroagh his
amt,the'buddividedtprsucM1impmvemwithinne intmddnipleoml for awes IT
OCC GROUP
RES. UNITS
withinorcyes orcmnPldm, the sewn
however,thebuilding«iten.f
Mmtishon
will hive tk buram.f proving dor he did rot build «'unprove fa puepve M
of
pi
QTY -1 PLUMBING PERMIT FEE
side).
.k.).
❑ I,a.owmrord,e rmpmy,.m eaelasivey.nlr,fin{wiW lice.d e.tna«.w
FI.tx3D ZONE
APN
cone. the rtoject (Sec. I0f4, Riniau and Profeuimu Cock:) The Cwuran«'s
Limue l..wdoes not apply tn.ownerufpmpeny wM1m buikV m'unryrretheme, eta
PERMIT ISSUANCE
w1bo amtmctn f«auch ponjavz with coca ctu(.) license Psr,toot tothe Contractor's
License Iyw.
ALTER - DRAIN & VENT - WATER (HA)
FEE SUMMARY
❑ Ism <aemlg order Sec. , B & P C f« tine trason
BACK FLOW PROTECT. DEVICE
1
SANITARY YN
Ov¢r Due
DRAINS - FLOOR, ROOF, AREA. GOND.
RECEIPT#
WORKMAN COMPENSATION DECLARATIONSCIIOOLTA%
YN
[IIM1cmhy.fErtn thatl Mve. renificeo Mcun,nuo,If-Im�m,mecertiBichens
W«kers'Ctxnpensuion ln.unmx«e cmlBed copy threuf(S«. 3800,1ab C.)which
10%"1 V RES - PPR'IAAP
RECE]PI'M
PARK Flit+ Y N
covert all empkryeel under this p.nit.
Polley Y
RECEIPT' #
GAS - EA. SYSTEM -I INC 4 01JTLETS
BUILDING DIVISION FEES
Cootrinny
GAS - E.A. SYSTEM -OVER 4 (EA)
PLANCHECK FEE
❑ Ccnifcdarpyi.hachyfumiihi
GREASET,M)USTRI, WASTE. INTERCEPTOR
❑ CeitiOd apy is Filed with the city inspection division.
GRADING ftiF:
CERTIFICATE OF FXEMf'ION FROM WORKERS'
GREASETRAP
SOILS FTE
COMPENSATION INSURANCE
SEWER - SANITARY - STORM EA. 200FT.
ENERGY FEE
(This sari. necd rot be mmpluN ifiths ri it is fair. hodred"fors S100)
«leu.)
WATER HEATER W/VENI'/ELECTR
I
I cenify dun in to, perfmmn.nce orthe work for which this permit is icwed,I had
not Deploy any peew i in any matuer as 10 Beane, subject to the Workers'
w
PAID
WATER SYSTEAEU REATING
Z
ZQ
C«nperutien Laws of C.Iif.d.. Date
Abcs
Detc Rac Y
NOTICETOAPPUCAM':If. after evoking this Cemfvte of Ex.Wtim,ym shmkl
NEW RESIDENTIAL PLMB. SQ. FT.
no TOTAL
become wb*t w tine, Wurkv'. Cons msau. povisiom of de L.bm Code yon muu
f«Wwith cunplY wiW.uch govisiovmthu panni, slWl bedmted revoke.
.BUIL G E
w o
z
CONSTRUCTION LENDING AGENCY
IFerebygrim Wu dqe Ismvo-uceim kNing+3a,>' r« the, pafvmuce of
SIJ.
AL ��
FlE FEE
I„ ) O
LS.
0
the wsA f« which Wis rami, a Tuned (Sas 309'!, Civ. CJ
LeMv'.
Nurc
IettJ Addr.s
QTY. MECHANICAL PERMIT FEE
PLUMBING FEE
i G
U Z
U Z
I ci
1coolly�Inocto (hove _.tod! thinity sued con ty ."re Wet the .Unice wsnelatim is
mmr.l gmto comply hereby lcdty nd emery.div a dY elaw. rtlo ng to
bulkdngronuruc0.,ud hereby repm.tadre of this city roster up. the
ebov trod. impmi. µtryoxv
PRM ISSUANCE
MI:CIVWICAL J: �.
ALTER OR ADD TO MECH.
CONSIRUMON TAX
(We) says.. uta do City on Coronion a
(We,) agrte w vve, iMertmifY and kap
in, in a Coy
'itie,judgm.u.wueMespvuu whichmny in any w.y acmceg.lnt.aid Ciry
AIR HANDLING UNR(TO 10.000 CFM)
o cottse, '6cft4the granting of this permit.
AIR HANDLING UNIT (OVER IO,gX) CPM)
igiw of Applivet(Conoweor Dte
E%IIAUSTHOOD(WIDUCT)
PAID
HEATING UNIT (TO 100,000 BTU)
HAZARDOUS MATERIALS DISCLOSURE
fte Rs Y
Will We .PN knot ir , Mu building occu,nucR, Ch,t Wore m hiiand di M1avNwi mauVel
ns dditxel by tic CuPcninn Municipal Cnk, ChvPta 9. @,.nJ the Ilc.lth unJ Svfdy'
I IPATINO UNIT' (OVER 100,000 BTU)
)IAL:
VENTILATION FAN (SINGLE RPSID)
Codc, S,Oim 25532(x)?
❑ Yn ❑ No
Will c t«fur W arderi
.pplicon Fining occupant.,
nnein
BOILER- COMPQHP OR 100.000 BTU)
ISSUANCE DATE
�.vrduua
Ain, a
air cmtnmimnta as Jcfrcd by tine B.y Am Au Quvlity Mavgcmcnt
Mons
I,trict,
❑ Ya ❑ No
BOILER -cUMP (OVER 100.000 BTU;
PA 9
NEW RESIDENTIAL MUCH. SQ. Ff.
I have ,ad the hu4nf.us mueriWs rty ini under Chi ser &95 of the
3
fecmtoyr
thtM1oaeft
binudialJoifnvemautsmt 2I.e,3n3hse0tn2pt 5it5yii.obfiltaonrnoOacitvlayr
d, o,er&q
twhich
JUL n ry
1994
uroSiratrtmoa
«u3ortusaPar.3cs
.Ci(xWuep
nCmtro
airy Ce
lgin
ac.wnq.
C�
V �r �•
v,s
Owm «auth«ia<d agent Doe
T
ISSUFDBY: _' '41
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