S 1958 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF - PERTINO BUILDING-ELECTRICAL MISIT NO. �5
BUILDINGUIVISION` APPLICATIONMERNIIT PIAMItINI:-SIF:CIIANICAh `�
58
BUILDING PR(q FCT IDENTIFICATION
BUILDING ADORESS: SANITARY NO. APPLICATION SUBMITTAL DATE
,0181i� �c o
^!(E: CON]RACIOR's NAME LIC NO
N)C CONTROL#
�DrF'. n.. R�' � LIC NO: AnnRFss: ❑ �Q
CONTACT: PHONE BUILDING PERh11T INFO
Iy 3 .tee EDContab Ot FIS,;Paid by Appliunt(initial) Irl. FJ.F,CI' PLUMB MECII
LICENSED CONfRACUR'S DECLARATION v{�u Q'I'Y ELECTRIC PERMIT 41EFI Wmhy atnmr that 1 an Iirenw al under rvvweat,of Clwptcr v amJOB DESCRIPTION
wiNScelinn7000),,f uivi.vm 3af the Bra' io Coda,aedmyliccmcis ESIDENTIAn full fomc anJdfn LPERMRISSWWCE $Fl)WL ❑KRCIIENREMODEL
U 'at,,1er,Claa hicM rz yAPPLIANCES-RFsIDFN`FIAL AUDITION ❑PLUMBING RE-PIPE
Dae Comrxmr
ARCHITIEC'S DEC1ARATION ELS ❑MULTI-UNIT [I STRUCTURAL
O p Z 1 umdrnmxl my phuta nM1ull W uncd na IN.¢crus UPMODIFICATION
21M),\MPS MODIFICATION
1-t?Fw IacenscJ l4ofaa:awl ❑INTERIOR ❑CHIMNEY REPAIR
C6Yf� OWNER-BUILDER DECLARATION 2II-ISXq AMTS 1\1PROVEAIE\T �SN'1\1.UING POOfS
C a Q I hereby alGrtn that I nm e.cmpt from the Comtradnr'e Liccnm I,w far the OVER 1000AMPS [I BATH REMODHIAPPAM Q DP.MOLfHON
K 3 a U folkewing maven.(,Satin 1(1313,Huvior%ISM Pmfessimv Code:Any city m county SIGNS ELEC TICAL ❑OTI IER
ul u. which receives a Isom m cmarvct,al¢r,imlam<,&.1M,or telvir.ny strvcmm
TWO prior to rnreuch,raoil to flco,eignal wmetncnt SPECIALCIRCUITIMIS .
<. }
had he i,licrnred purwaal.the pmvivorra ofthe CavrletNx license Lai.(Chaper9
I�i1�C0 (crmtmercing with Stttion]LX)0)nf Divivm JofBe Puair,a.aIle Pwfc.simu Calelor TEAIRMETF.RORPOEEINST. COMMERCIAL
L L that hu is esemPr tbemfrmn utd the Mia Lx the ullegal nmo,loo..Any viulotiom or N BLDCIADDfHON ❑DEMOLITION
,�E S citm 1031.5 by aay.,fiwant fr. ennll sohjedv lM apPlicannn ecivil prnahy of POWER DEV
ICI!S or) fF1JAN ❑FOOD SERVICE
FZ
rad mxc than fie hundred"Be, 5500).Y OTHER
will
SQp ❑ I,tu k-ok.f the pnryeny,or k re,ot odcdoc0worgcbaealcthei ree7flele tpcn.mtem. SWIMMING POOL ELECTRIC KYY``1IF�9�Tfr
F will thi fav,n .ande The amrc ianotlnlmdrotc ave Id for Talc(sa,]1W,0uaircv ❑OTHER
ab I'ny.1bo CotlerTheove,,hro L'ecve Low Joea rtd W'Wy to ,n:7 of �, OUDI.EI'S-SWI_TCI{I!S-Fla TURFS
proPrry wM Mild,a impnovcs themm,and wM10 Joos such wo,nk M1imsclf«though
his own cmplayrea,pr-iikd that wch ImProvcmcnta arc not iroctdlJ or uffcuvl fur NEW RESIDENIAL IBICTR SQ FD.
as If,howcvcr.the Wihlineorimpmscmentis-W withioorcymrofcmyrktiottbe SQ.FE.FLOOR AREA VSQ 17K
rcrhuilM will have the W rden of proving that he did rte Wild or improve fa pru-
Pr,w ofwlc.l.
❑ h o.rmmr of the properly,ant esduunly cantruring with I'renseU ennuaeum w l U1jy
caasrvct Be project(Sec.7H4J,Baaineas awl I'rofessimta Cuta The comtractoh 7�0 _(✓it
neladro urn sv apply ton owner aofpropcny who Wllds,a impravea Ilwo—,and QTY. PLUMBING PERMIT FEF. Jr-
who controcrs fur wch pmjcaa with a contravr(s)Bedard pucweot m the Como-ehwe
Licrnsc law. PERSUTISSUANCF, 3 �
❑ 1 oat cacmPt omlcr kc. .H R P C for thio ocawn
Or nate ALTER-DRAIN&VENT-WADER(1A) VNAAI'ION
WORKERSCOMPENSATION DECLARATION
ECLARATION B\CK FLOW IR(IIC .DEVICE
I herebynfrnt wbim Penultyofryrury tineofthe O,Ih,wing dlorwonn' 02: C_
C] I have erd will rruimain aCeniticm.of Coescnun wlf-insure fir Worl,—Grorpun- DRAINS-II_OOR,ROURARFA.CONDSTORIES TYP1!CONSTRUC`HON
sari.,,,va pruviolN fu by Secfon 1'1X0 of Uc LISW Code,far the per(nmrarce M the
wool tor which this pennrl i�u 6 fIXTLR[S-ITER TRAP
❑ I have erd will maintain W 1 C.11"o , Iletnsoe..aWrpaf +1 h 4rtinn
3]OOofdtela Cede,far th a t nA farwh tM1i.a pemutn sane`. GAS-FA.SYSTEM-I INC.JOUITETI ICC GROUT' APN
My"ea 1
Cmric acs l'ol'ly Nn. GAS-EA.SYSTEM-OVER 4(EA)
CERIIIIGT' )I,NSA¢ftY lSnCai/\haNaxR ' GRfIsSFIINDU.Sr1U.WASTEINTERCIiPTOR
--77 rr(y�}sNX 1V1 BUNL) 'IS ON TIES
(TTia wetiun mesal. omplcuslr dnpc ti J IS100) GRI:ASH']RAI'
nr bn.l 1'IANCIIF,CKf .
I eenify tM1at io Ue pe eMthe work Erxhich,hispnnet"a ISEWER-SANITARY-STORM EA.200 FT
vont cnploy any lurxou in an nQaerwas to hccm,c whjccr to the N'orlcr.� on,'pc.-n- ENERGY FEE
OZ mtlnou-ofcelifomio.l 11 WA'niR HEATER WtVEN(ELECTR
z O Applicant GRADING IYE
h NOTICE TO APPIJCAN:If.doer nal thio Ceni feat.of Eaempbnn, u. ld WATER SYSTFAVDREATING
becunr wb)u:t to the Worl C...npcnsatiun Provimoo,nl tlw WWrGat,you nmol SOH-9 ME
fi.hwith comply with wch provisions orchis permit sha11 be Jrencd ravakcd. WATER SERVICE
Q
7 z CONSTRUCTION LENDING AGIiNCY NEW R191111;NfIAIJ'Ld1B. SQ IT. PAID
C..) p IWe which Ban
caro,aii.d(Se 3Olcmlie.egcruyfr Na,pertrm,wrecnf Ilam RmciptM
w — Ire watt mr wnieb thio peamit is iaw,ed(see.wv],em.e.)
O U lace ce,Nor. 0 A TOTAL:
Lt1 Lc�'sAdtlnsa TO
y I reatify da.1 have read this application and orate that tk alwvc infomutiom u HU11. N'G I .E
V) corncr.l agree to comply with all city and county ordinances and stem lanai mlating to QTY MECHANICAL PERMIT FELE
U Z building eanetrvetion.nal bendy atehnrien maraseutatives nfthis city roeoterup,m tW SETS. 1 f O
above mentinnrd poa,e"for inapeetiat l',roes. PERMIT ISSUANCE EL 1 Fl:I:
(We)agree m eaae.irdearnify and keep hers as the City or Culcniruagaina
Iiahi111hx,jo,ignenu.cut.a atd npcnwa which racy in;my way accrue against wid City ATTER OR ADD TO MECH. PLUMIt Gllili
I.mia"t enee of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N 0.POINT AIR HANDLING UNU ER)10,000CFM)
SOURCHREQUI \TONS �p11� ME '[CAI,FEE Q
AIRIIANDLINGUNI'f(OVER 100)(t)(CFM) CONS'IR ION TAX
Signlm'reo AMIxint/Gntru-tm V IV J . E%EAUSTHOODOWA)UCf) HOUSING CATION FEE
I12'ARnIIDSM SIIISCLOSUHI
Will the epplicmt,r Tuve ,Jing owcuprarn aloma Mndk hvvdua mamrnl HIiAM'O UNIT ITU IIMLB00NN)
as defrted by tk Copenim NfunicrpeI ode.Chywcr Y.13,and de Heultb acrd Safety
Gde.yar om1a51200Y HEATING UNIT(OVER IDIIXX)ETU)
clYca PAID
VENTILATION FAN(SINGLE RISID) Dam RecciptM
Will the opplico ar or[aver J fi .vryvn uw eulPrncm ear Maintaagein which BOILER-COMP(3111'OR I00,IXU H'1'U)
,it ltarsA,ue'air nrmm�tinwts m Aef by the ploy Arco Air Quality Maacgnrcnt
Diataici! BOILER-COMP(OVER 10lLOB(l BTU)
E]Yn
Ih lea, anrwcriala - AI R CONDI'I'I ONBRf. ISSUANCE DATE
reynremcnta ear Sk .I ubtl fi v5 of ea Cdi-
,b)0 ahh&Safe Cotyle.Sectioru 253f)5,25531 vd 355.U.1 ontrrstud thead cite NI:M'RESIDENTIAL h1ECH. SQ.FT
WI ng Arcvn ndy M1ovcr LINA II is my mPrmnr 'Illy mnnify the fvao` oat
raquuc 1i m c .....
art prior to icanrec vv .
rr15-
wlurrim gent Dam TOTAI ISSUED BY:
OFFICE