24508 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPF
BUILDING
-ELECTRICAL PERMIT NO. 24508
APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING DIVISIOSIO NO N BUILDING PROJECT IUENIIFICATBJN
HUILUING nrDw_DRIwSS:
UNITY LOT♦ SANITARY NO. AFPU
LICATIONSUBMTALDATE
W `
11 Z��
WNERS NAME:
PHONE CO CIORS NAME LIC NO:
U MLI WC CONTROL#
RCIIITECr/FNGINEER: LIC NO I ADD ES : Z pq, ❑
CONTACT: PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PERMIT IN
SLUG ELECTPLUMB 91
PERMIT ISSUANCE. \Ldl�7
Io tho I
LICENSEDCONTRACTOR'SUECI.ARATION APPLIANCES-RESIDENTIAL �� ^ TOB DISCRIYII011i�
ply In7") ffinni.3cli.n,ed under,eovisiorsnfCTvplyr9(camrncaingwilh '^ `A'{�/11'�•
gx[00 NilScettomeeacl)cffeclrisimJddc Busircnad Rofcssions Code.u,d mYlianseuin pnNELS .✓
Bane Clan Lit,♦ UP TO LIO AMPS
y6a Dme Cm,.,or ZUI-IOW AMPS
70yZ ARCHITECTS DECLARATION SQ.FT.FLOOR AREA "Q,FT.
OVER 1000 AMPS
OZ_M ImN ,;mcf myphns mull be uxJe public ectad,
W SIGNSELECTRICAL
I,a sd Pmfess,anW OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
IKt131+�rF¢it folW lwmg,.,.,maffirm
(S.Iiorlmit
]0713.Huspnesan Pn fnaw�n.CWc'AnY cicense�or eaunw for�iye TEMP.MBTER OR POLE INST.
NRA/ Lf�J'S� Ep '—II �^IN
u'Oy J which reyuiro a pemdt to cmwnrt,alto,improve,demd'Wh m repair tiny v me ® O"J tl tl (I.J C !� 1
Sa T� prior to il,iss a ,nlw r,m,c,the a, icanl for im,h rmi,to filcuaigadewemrnt POWER D; CFS
Y]z p Out k U licetocd lnvsuwt to th<proviriom of tk Co. litems 1sw(C1lvpte
a 9(avnmcm'mg wilL&cii.7000)ofDivl.ioe J of the Hudnei,end Pwf.1mc Cole) SWIMMING POOL ELECTRIC U
rso mNm lc iscxcmp Nerefrom and Nc bay.fabocoti , cxcmpi to civilplmion of OUTLETS-SWITCI IES-FIXTURES TE
FLa Smliun]W LS M1y anye,plirant fwopemit wbjeeu We aPpl'w`aed loaciril perehy of
ria more than five hundred!dollop($.50B.d� NEW REg1DFNIlA1.ELECfR —SQ.FT.o ❑ 1,a,v+mcroflnepwpeny,nmyemploywwilhwag soul wkmm ion, STORIES T1PE CONSTRUCTION
a3°= will dolltework,"die,'Im"mei.rid imen4d a nffe,ed fvr.le(S..]M4,Buain
"Pwfeauau Code:The Contrnclora limy Law doe not.,ply to an owmcr of
,rcl whobnild.mi.,nowc,dcmun,end whodca wch work ninlxl(a N,wgn hu
cmpbyegprw ❑ut.uch impravrnrnuem lctimedcdaoffered far We.IL OCC.GROUP RES.UNITS
however,the huilOing or impnvm em u"d within me year of completion,Ny owner- O
builde will love the IwNrn of proving Nat he did.build a improve fa puryose of SO
mk 7.
❑ I,mnwrcrofdc propcny,emudwvdyu,nvaningwiNlianeM cammclon ro QTY' PLUMBING PERMIT FEE FLOOD ZONE APN
comtmet[he onject(S..90M,Bmircn sod Nofcaions Cod J'He Conrado'.
licerve Lew Joe rot�plymwowmnfl*❑pony whobuildraimpmve 0cmon,end PMAHT ISSUANCE,
wnocmmlrwta favwhpmjecks wiNamnuocta(,)IirensM puuunt mNecaemmoors _L 1 11
ALTER-DRAIN&VCIJt'�WATER(EA)
IJccme law. FEE SUMMARY
❑ I mn eaemq under S.. ,B&P C fa Nis reason BACK ILO"PROTECT DEVICE CUTS,1
Owne
SANITARY Y N
Due
S
DRAINS-MOOR.ROOF,AREA,GOND. RI:CLIPTN
COMPENSATIONWORKMACOMPENSATION DECLARATION SCHOOLTAX YN
❑ Thereby off ttwlM1aveaceni0um ofcamrnuo mlf-itwm,aecatifirme of RECEIFI'N
Workes'Com 1 Fon lewrurce w e artifiWTURFS PER TRAP �^
pros+ co,NPY lhcrtof lScc Jtl00,fab C.)whlch PARK FiE Y N
m W employ.',under Nia pO m, GAS-EA.SYSTEM-1 INC.4 OUTLETS RECEU`T N
Policy YBUILDING DIVISION FEES
Company GAS-EA.SYST1rM40VFR 4(EA) PLANCHECK FEE
❑ Crnifcd coPY l.lertbY fumislcd.
❑ CeniflM copy is fled wiN Oc city impatinn division. GREASFJPNDUStRL WASTE INTERCEPTOR GRADING HE
CEIGIFlCATH OF 13%EMNION FROM WORKERSGRFASETRAP SOILS FEE
COMPENSATION INSURANCE
(T11..,I—need not be comwlcled if Nepmm,u for one hedtd dollan(SIFB SEWER-SANITARY-STORM EA.3WFT. ENERGY FEE
or Teat)
I certify that in do perficono rc of Ne work for which tloz pemdt u in„d,I dull WATER HEATER W/VENT/ELI:CIR
not employ any etwo in eny mormer w,so to become mhjecT to the Wotkea' PAID
,z Conlpevmion law.of Califomie Dote WATER SYSTEMEATING Dee Recci,IR
Ap,licvnl
z 0 NOTICE TO APPLICANT:If.after mmking thk CeNRere of Facmpion,you.Mudl NEW RFSIDFMIAL PLMIL SQ.FT. TOTAL:
1-" y foodiwit auhuMly*i voeker's Cvmpenr Ids movil"ll f doemodr Cale,yau mist
fmNwiN rnmply wiN sixty pwrinasw Nis permit shall be d¢n,d mvokM. BUILDING HE
0. CONSTRUCTION LENDING AGENCY SEISMIC FEE
Z Ihaeby.Itlrm Nnl there is v commotion lendingfor the perfomun.M -
V O the work fa which this permit i s iawed(S..MKO,Civ.C.) TO ELECTRIC FEE
Lenders N.
O F Ledrf,AddresPLUMBING FEE
, QTY. MECHANICAL PERMIT FEE �•
V 1 certify Not I hsce read dds application"s....Nd the above inhomo m.is
0. ,necl.lagrt mco,ply wlN Aluty dmunty oNinwcevWswelew rel,om". PERMIT ISSUANCE MECIIANICALHC
_ Z bu)vc-mentioned an,aM herebyauJmi mtoc v wiveaof Nia city to emeupa tnc
V z aMw(We)1oncd 10 mMindlemfy,Ind keep
ALTER OR ADD TO MECH. CONSTRUCTION TAX
(We)agree ,vve,indilCXFe and keep hnrmksc the City of Cu,entro ageinu
Iivbilitie.jWgercnts,coma"expemevv m may' vnywitywmueagahstsad City AIRHANDLING UST'i 10,03sCFM)
rte grv�ing il.
AIR HANDLING UNIT(OVER I0,000 CFM)
49z
lIgnIsurowAlphrisidlEOEmictor EXHAUST FOOD(W/DUCD
PAID
IA RDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 1X,100 BTU) Dote Rece1PIN
Will tnc applirent or fmum building weulun Von,or brindle heenrdau,rwtimt!
e dcfnM by the Cupenmo Monicipvl Cock,Chasm 9.13,"the lleelth aM Sefety HEATING UNIT(OVER 1W,"BTU)
Cde,S.tiye,, :' ❑N
.)
0 VENTILATION FAN(SINGLE RESID) r
Ye
Will lInevp,licmlmrfmureboilAm azo BOILER-COW QHP OR 100,(00 BTU) ISSUANCE DAIS
g pant use CGuipnclllwdcvicev wM1len emir �1
horudou,eI,coiomi unu n defined by Ne Bay Ata Am Wallty Khm,,mml BOILER-COMP(OVER 1(Nk01M)BTU) I�^ A � D
District]
ElYes,
i]
Y. ❑No NEW RESIDENTIAL MECH. SQ'TT IYOV 2 3 IQQI]
I have rd the hotu ma " C'he
mate".n,utre nvo.under gg695 of SO,
Coliform.Ing &Safety Cody,RveRts253115,2537]ed2151(. 1iiyic)eld Not
ifcunint of gdome.nalcmmndYnavea¢trot,lei iitivmyreslwumi a mtestasof
weupem nr Nr mRairrmrnn which trot Ix ma lata m =,w,.a.nr a ernifil�r nr I I t Vr (;UYtn , 0v 1
am,lvnry. —95
Owner nr emhori'md egrnt Doty T A : ISSUEDBY:
OFFICE