S 3148 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPE RTINO BUILDING.ELECI'RICA I. RM fI'NG. 3148
BUILDING DIVISION APPLICATION/IlPLUMBING-MECHANICAL S
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS SAN[I'ARY NO. APPLICNIONSU111,1I1-I'AI. )ArF.
\L\�\ �V�
OWNER'S NAME: 111ION17: CONTRACTO "VAME CNO
` , NIC CON'IROLp
nu x to
ARCHITECT/ENGINEIiR: LIC NO'. N DRESS: `1 ❑
CONTACT: PHONE: BUILDING PERMITINFO
❑ Cunsullanl laces Paid by Applicant(Initial) NLDG ELECT PLUMB MGC
LICIiNST:D CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE I El
I hereby infirm thin 1 oar licensed under pmN.hnl.of chapter 9 Uommvmdng JO DESCR TION
C5Z with Section of Di vision 3 of the Hunine,and Pmrn.inn.Code.andmy license n: ESIDENTIAI.:
WOO wu PERMIT ISSUANCE
Z"T1 in full Tose and eRaO ❑SFDWI, KITCHIiN RIiMOUiiI.
<-U License Class hic.p gl'1'LIANCGS-RESIDENp1A1,
H G W Data Contractor ❑ADDITION ❑PLUMBING RE-PIPIT
F7w ARCIIITECT'S DECLARATION PANELS ❑MUI.TI-UNIT ❑STRUCTURAL.
ZONZ Iundemm�dmy planuhallnemeTuOspuM1licradorl, MODIFICATION
14- UP TO 200 AMPS 0 INTERIOR [I CHIMNEY REPAIR
04N2 ; Licen.eJ Ptofe..inwl 201-IOg1AMPS IMPROVIiMENT SWIMMING POOLS
B ol C Q 1 hereby affirm hWNPRat I ^IotUllmpl Gem the C n lmnor's Liccnac Law for rhe OVER IOW AMPS ❑BATH REMODEIIREPAIR DEMOLITION
xsx OaV followm (Section 7031.5.Themes.mul Profession,Codd:An,cit t ❑QI'HIiR
W 3 U.T' which requires teams 1 fiction to construct,alter,i0) demolish,or repair y^sny tructure SIGNS ELECTRICAL
robs ismaac..ino,o thea Iicant hvsvch nn lilcaniad,ucmcm /
prior quires Pp pemni gaw SPECIAL CIRNIT/MING.
(hat he commencing
licensed pursuant to the previsions 3 the ConttmnrzsndPLicense law(Chapter 9
Cap kommenciog with Section 7000) Division the Business and Professions Code) "cGMP.MITER OR POLE INST. R 1 1'
Q.X o a that he i.exempt therefrom and the basis for the alleged exemption.Any violation of ❑NF.W BLDG/ADDITION ❑OFiMOLITION
Section 7031.5 by any applicant fern named subjects the applicant I a civil penalty of POWER DEVICES
not mine thin Hie hundred doll.,1E5W1. F: ❑FOOD SERVICE
F-Z} OVEMF.NT
Sat E] 1.as owner of the property,or my employee,with wages as their compensate.. SWIMMING POOL ELECTRIC
will do the work,and the structure is not intended or offered for.ulc Sc,7041.Basiness ER
13 m and Profession.Code:The Comm dor'.License law does not apply to an owner of UI'LEIS-SWITCHES-IIXTUR S ZZ
property who builds or Improves thereon,and who dms stdb work himscl(or Ihrem,
his own employee.,provided that such improvements are not intended or earned to NEW RESIDENT IAT.ELECTR SQ IT.
sale ll;haweveq tire building or nnprovement is sold with'm one Yeanff complminn,IM1c SQ.. ee
-builder will have the nunlen of proving that he did not hnilA or impnwe our par- yj
p eul I L �i tl D
i f the p p ty IY I f 6 with licensed contractors IllTOTA
construct th project(Sea 7I44 Busied,and1 t C I 1 Th C t t rs I.P.
Law J ,applyt f property who builik(it inellroves liencon.and QTY PLUMBING PERMIT FEE NOV 12 1998
who,drafrecl,formOp 1 n will,aeon,r t ()lcensed po :na.am to the Co nmctors
License Law. PERMIT ISSUANCE •s
n Iume raptunder See. .It N PC for only ruuun
AClilt DRAIN&VIN'1'-WATER(EA) Bp VALIIAIION
Owner Uma 11
WORKER'SCOMPENSAfION UIICLAItRUON BACK FLOW PROTECT.DEVICE
hard dl reatrackspcmdtyofol Conatmof,11fallowing WoAciams:
� Iltavc and dl t...by esdi r 3eneaf Consent fit sclbimure Eu Workcr'.Cangero DRAINS-FLOOR,ROOF,AREA,COND.
S'IbRIf:S 'fYI'I?CONS'I'IeUC'i'ION
stink,us provided tar nY Suction l]fXl nl the Lubar Code.I'nu the parfonnunee of the
wurkfa idM1 thisndm.,it, lsotmd. FIXTURES-PER TRAP
h.ve vnd will Cost
fon Worked Cmcc ul It,.w Insnnawe.whi u.r is Pati by Swnian
Wnf the labor Code for the perGtnnvnm of lLc work lin which Olix permit i.issncA, GAS-EA.SYSTEM-1 INC 4OUTLETS OCC GROUT' AI'N
y Work- lau(yaaon II�mrane y vnd Poliey t
Carries � xl'nliey No. u�r� GAS-EA.SYSTEM OVER 4(CA)
CERTIPICATEONIiX1iMl'i'I(INIHOM RJt. . O 1
COMPENSAHONINSI/RANCE GREASEINDUSTRL WASTE INTERCEPTOR
HU .)TNG DIVISION FEES
(Ihiss.cclinn,red nanMronlpleted it the pcnnit is fnranc hundred Jnllam(S 100) GREASL'TRAP
or Icss.) PLANCHECK FEE
Toy any tperom he inion,remanccol thewnrk lire,chd this thein i.irsu C shall SEWER-SANITARY-STORM EA. I'T.
oat employ any person in any manner m as m Mctomc suhjcn m the Workers Cnmpen- ENERGY PEE
z ,2 satin,law,of Cvlifnmia.Data WATER HEATER WNENTMLECTR
2 Applicant GRADING FEE
= NOTICE TO APPLICANT:IL after nuking this provisions
me 91 li¢mptio d Yoa should WATER SYSTFWI'REATING
become comp y the Wnrh po Compensation pmv t steel of the IaMr Cdc,you must SOILS FEE
� forthwith comply with such pnvizinns nr lois pencil shallMdecimal mvokcd. WATER SERVICE '
a �
CONSTRUCTION LENDING AG17NCY NEWRESIDENTAL PLMB. SQ.FL PAID
J z Dae "-I-
".
Rattipt a
L) l for
thi that issued Semmn len ding agency for rhe perfomuuncc of
the work for which this permit is issued See.31r)],Civ.CJ
QF-' Lendets Name TOIAL:
L) Lender's Added, TOTAL:
I ecnif Ibm 1 Lave read Ihis a I t s0)¢that the Note information is BUILDING FGI!
r yr in ion and
(q cored.l agree to comply with all city and county rminarwcx and slate laws relating to Q'I'Y. MECHANICAL PERMIT FEE
U Z building construction.and hereby amhorux representatives of this city to enter upon the SEISMIC PEI:
anovcmentioned pmpeny for inspection purpuscs. PERMIT ISSUANCE
(We)agree m rave,indemnify and keep harmless the City of Cupenino against HLECTRIC FEE
leffidtics,judgments,costs and cxpnw,%which may in any way accmeagai,.amid City AL'T ER OR ADD TO MECH.
in megaence ofthe granting of lhis prmit. PLUMBING PEE
io
APPLICANT UNDERSTANDS AND WILL CO ALL NON-POINT AIR HANDLING UNIT(TO 10.000CFM)
SOU .REGULATIONS MECHANICAL ITiii
AIRHANDLINGU IT(OVERI0.000CPM) CONSTRUCTION TAX
Signature of AppleurmCnnnracter U Dane -1 EXHAUST HOOD7(W/DUCT) • C HOUSING MITIGATION FEB
HAZARDOUS MAT17RIAf S DISCLOSURE
Will the applicant orfmum Wilding oucupam store orbandlehvallous material HEATING UNIT LTO I00.000 BTU)
as defined by the Cupenino Municipal Corfu,Chapter 9.12,and the Ilcallh and Safety
Coda Section 25532(.)! HEATING UNIT(OVER 100,000 BTU)
❑Ye.v E]No PAID
VENTILATION PAN(SINGLE RFSID) Dwe opt#
• Will he apdua nl err Rause haild.,occupant use cgn'mmet or devices which
nuev0) m
rdo., r cumainanlx as demx
nl by the Bay Areo Air Qaanir Mnnagcmcnn I3011AR-COMP OHPDR If)fl,(KHI BTU) ALA
crah
Do.idet!
❑Yes 0 N BOILER-COMP(OVER I0II.0001ITU)
I have and tic huevrdou,mmeriulx reopiiuonucm.under Chnptcu'(i95offlcCali- AIR CONDITIONER ISSLI )ATE
forma Health h Safely Cuda Samoans 2.5505.2.9.93 and 25534.I nndenwnd thal it Ale NEW RHMIDEN'I Al.MECH. SQ.1-1
hmildmgdre cndY luvuamn:nn,thou it is niy mspunGnility it,ably the oxcogmnl
carr
,if the myuimmona whid,nrvct hu incl a mm i-ease-1'.Card 0cutu of(kmgwncy.
Owner or emhmivnd again Dam TOTAL: ♦ ISSUED BY:
OFFICE