S 3383 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUIaEK'EINO BUILDING-F.I.RCI'R1CAL PB I-No.
BUILDING DIVISION APPLICATIONMERAUTPLUMBING-MECHANICAL 3383
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL TATE
r-r
OW1 O�A� ~ 1'l1UNE CONTHACG)H'S NAME LIC NO: 2
-� � 6^ 11 Q� /,/ _ I -1� N/C CON]KULIF j
ARCH]'I'R—PENGINFX,R; LIC NO: `1 ADDRESS, w'L(,yLrl/' ❑
C. l 4wvi OLiz-
CONTACT 'HONE: 1 Z BUILDING PERMIT INFO
❑ Caruvltant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
❑ ❑ ❑
LICINSIJ)CONRACIOR'S DLCIARA'IION QTy ELECTRIC PERMIT FEE
1 berehy of ria Thal I un heenacd umkr lrrwiumis M CTmper 9(c�'amnuneing JOB DESCRIPTION
005ct, wilhSmirn]fMMO of Divisum Jofthe BusirlawMPm6xdomeCorc.alW myliccmcis RESIDENTIAL:
00 In full lira wxl off PERMIT ISSUANCE
y,41F ❑SEDWL ❑K NR FMQDIi
aUU Lmrn lea Lie.N—� giry'LIANCIS-RESIDFMIAI. ❑ADURION ❑PLUMBIUMBING RE-PITC
N6y Dqc TSI)El«
r,py AR oball u uPuNiRAGON PANELS ❑MULTh11NIl' ❑TT MODIFICATION N.
Z p v-L 1 uNletalurd my pl:vs doll or used n.0ublic retold MODIFICATION
OZ—O UPTO 2(MInMPS ❑INTiRLOR C1 CHIMNEY RLJ'AIR
pi Licenced Profck.Lxidl poi-INX)AMPS [MMOVEIIENT E]SWIMMINGP HS
gay7OWNER-BUILDER DECLARATION OVER IWUnA11`S ❑BATH RFh10 fJ1RCPAIR EDF.\IOLITION
c C S 1 hereby affirm fti I NI exemq frail Inc Convacon's License L—for the
K O 6 Uy. m
follerwin, eum.(Section 7031 S,Buri«.0 ud m
Procooe Cede:Any lily.,cont, SIGNS ELIiC, (CAI. OTHI'R
3lL N whim".ircr a erPor any xnucwrc
FLLO¢ prior In iu iauuree,elwIbco li.fm mrh Permit to flea uprrt mucmcnt
.] rryuira PP SFryiCIAI.CIRCUIT/MM.
Ihuhe islice,il lSe,tr,lnllraPrefers.nfthe
ic W,.l0!'slJcemeLow(Lloric)-
Wa00L6aL Inawia caemry tN:�tud the iviniai lufdm laiQil�samul l9oafcnaiunaGwkl« 'IP.Af i'.MEI'I!R OR IroLE INSf. COMMERCIAL
fcanmcwin 'I IScct'lorn tom(tfT
ss Muk.!«ate iflberexemcrioa Anyli I,y of ❑NEW RLDG/ADDOION ❑OIiMOLR[ON
xmN Satin 7031.56 licent fa a Pcmlil.unjrclsok applicam tnacivil perlallY of POWER DEVICES TENANT ❑FOOD SERVICE
Ixx neve time live hundred!dollars(5500).
IMPROVI;MEM'
iSQp ❑1,¢r owner of the pngnny,or my emdnYee wish wags as their sole oUlllp[nNlinn, SWIMMING 4rc R)L IihEC1'IXIC
willdathe wont,and do malum is ilvmad«nReIN f«sale(Sec.7011,inti ser ❑OTHIJX
L 3 aM Professions Ccr :The Crnl.lw'e Licence Low docs mil o,,Ay m un rwnur n( OGII.LTS-tiW ITCIIP_S-i*I%TURES
Pop y who wild err inlpmves IIIITron,and wM docs sled work himself«Ihnogh
tis awn cmpkryn:a.forAlded film i;uch imprrce cede arc W inteMdl a offered for NEW RESIDENTIAL OEC.'If S6 FT.
wk.If.howevenfhe buikhngo,volmoenrnl ie wld within scyear nfmmplcliun.the SQ.IT.FlGOR AREA ysQJT,
puer.lndller will ww me Laden of Pmrin,Iwt he did oat wild or'lnlFmve f«pur-
orWc]. 11
El 1,a.ow K1 of the Pn,Pa,y,mil r.ausilely cat—ting with loo w rrntmroa„to e)rn1
MLnmcl be froje,(.Sec,70iU.Ian sr aor ProE,.r ns C«4:)'Ihe(70nlr¢trrL1 IA-
«r..e law dre.caxapply to w owllernf for y who nuJda«impovec therein.and QTY. PLUMBING PERMIT FEE
who ermlril,for Wch linjeel,with it conlr orD)Iiecrl dPorectu lIn the COmnnur'n
Uccnw law. PERMIT ISSUANCH
❑I um exemlr under See. ,It&P C for Ibis reason
ALTER-DRAIN&VENT-WATER(FA) VALUATION
Owner Dam
WORKER'S COM ITNSAI'ION TI!CLARAI'[ON BACK FLOW PROTECT.DEVICE
I hereby affirm miler Penalty of perjury one of the follow ing dccluarims:
I hwc end will maintain n Cenifi,rl—FC.,olto¢If-inwrc llv WoM1ura Cnmpin- ORAINS- LOOR,ROOF.ARIA,COND. STORIP_S 'TYPE CONSFRUCI'ION
its PmvirleJ for h,section 37x1 or Ibe lame Calr,For INC perfan ace of Inc
w
ork favr x tach Nis permit in i,m , RCTURES-PER TRAP
1 ne anal wid maintain Wnrkera Cerro s eim Inwnnce,u required by Section
7(M)uf low Wwr Code,hr the Perrnore,c of lwworl,for which inn permit is rowed. OAS-EA.SYSI'LM-I INCAOUTLEIF OCG GROUP APN
Y Wakera Coal Qtenn bPolicy namher dToc carrier dart Poli , CAS-FA.SYSTFAI OVERJII:A)ama Policy No,
CHRTI ICATE OF H%I!MITION FROM WORKERS'
COMNNSATION INSURANCE GREASE/INOUSTRL WASTE INTERCIWOR
BUILDING DIVISION Ff!FS
finis m'[lian heed GRIASETRAP Ix,t lr canpere iDhc frrmil is r«nK nlwrcd d¢ga�(slao) —
err(car,) PI,AN'C11ECK Il]i
I mnify lhal..the pe noxnmannftbework forwhich lhi.Penni)i.cld1ana11 SEWER-SANITARY-STORAI EA.200FT.
rot eroplryany luso in}aonyynpmnrsraa to to the Wohrls Conyrniky -,niENERGY FliIi
zO ApldlirumGCH 9 IJII)fPk t �� WAFER liVAO!R WNINTA;I.FCTR GRADING II[E
N NOTO A .If,after making(Jim Cmif Ie M I:xemfXiw,yea sboald WATER SYSFENIU'Hi\TING
h -subje.r to the Wrc rrs Cslp ecaliun Irtoviviunw of the Labor Code,you roomff"' SOUS FEE
rnhMdiUmPly with...hPn,,isiomur dos Panni)shall bei Jredncd mvokul. WRIER SERVICE
a OCONSTRUCTION LENDING AGENCY NEW RESIDh A PLM I' .
. $Q PAID
U O Ibereb,.11me,lwl mere,,aconamcron letloling agony fn the Fr.rfmminc,of —194
hm R.x<i1Ma
{S. — the w«k for which dii. .t,,laved(,See.RM,Ci,CJ - TOTAL:
O Nader,Name _ �. v (,r t n
W LenJcrx Addta.r
>' 1 ccnifY lMl I Mvc reed thio application and sum tMt dr aWvc Infontvuinn la
BUILDIN(ft
FVal conecf.I agrtcwc.vnPly with all illy and crnmy adrnarcn.mf nuc lewY rclain8m QTY. F HANICAL PERMIT E
(..) z huildinge vmuion,and h�yeutburl®repruxnlulivcwof this city tocmeronoxuhe SEISMIC FliI?
awve-nrntine cl totem,lin inepecti.n Purry..e.. /''�
(We)ape to sone.imkmnify aril kccP harmless the City a Cunerlis agmen PI:HMTF ISSUrT.'CL"�����_ EIECfRIC Flt D
liabilities,judgmeet,m sand expenses which may in any way varve egaiml wid City ALMR OR A DO TO MSCI I.
m".—o ofthegrammeof'hie pco,iL i'LUAIBINGIE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR ILWDLING UNIT(TO 1h0110CTM)
SOURCE REGULATIONS. MECHANICAL F-cE
AIR HANDLING ON['F(OVER HI,M)CPM) CONSTRUCTION TAS
Signuum MAwliccra Comlmm Doc EBl1AUSTHOOD VMUCI)
IIA]ARDOUS MA'IP,RIA1 S DISCLOSUREHOUSING MITIGATION M217
Will theapplicant-future wiming rccvpant nurt«hulk hm"wsm„•Hit HLAGNG UNIT(TO 100.000 BTU)
u dcfred by tK Cupeninu Aluniciryil Core,Chapter 9.13,and Ibc HeaaM1 and Salify
Cock,Section 255120V HIAGNG UNIT(OVER 10QIXX)BTU(
[]Ycs ❑No VENTILATION FAN(SINGLE RESID) PAID
L Will ltr a lieant a fomrc buildin ct t uw I«�ice.which Dam Receipt N
ga Pan ryugirQu BOB,I!N-C(IMP(311P OR IfX1,IXX1 B'TU)
mil M1vaNuua air nimvninants as okfircJ by lhC Huy Arca Air Uuallly Managcnrm
TOTAL.
U.mrkt1
❑t'e. F1 No BOILERER 10TU
-COMP(OVBOBO B )
AIR CONDITIONER
Iluve Se cfcrc Cerc,Seoru ri YA.0 533ite oilier Chmcco93 afore Crit- , ISSUANCE.DA
lt
Tania Ifintilb&S tioci Cak,a Pins 25505,2 roy ti 2SSN.I urduslvd ilio if lir NI;W RF_SIIlINT1Al.MECH. SU.I'1'. 2 -3 ^9
with ngluirc whicyhuvaalRmr ariorl it gory cofimh iris eotOfy lcu r 'm
Nthc rcyui rcnu whim nrvtor rrl laiatu isvmrre ofaCmiflcor of(kculval.
Owner nr a nhori W agent Date TOTAL: ISSU17D BY:
OFFICE