30086 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPEIMNO BUILDING.ELECTRICAL PERMIT NO. 30086
BUILDING DIVISION APPIACATION/PERMIT PLUMBING.MECHANICAL
BUILDING PROJECT IDENTIFICATION
BUILDINGADDRF'_SS: 1,+I �� SANITARY NO. APPLICATION SUHMfITAL DAD
n r
O NER:S TN7 hili
M I 10 _O CONTRACTOR'S N E LIC
AamfOr N C OL
�UtCH1lECTIENGINIER: LIC NO: ADD S: (� ❑
CONTACT: PHONE: JJ BUILDING PERMIT INFO
❑ Consultant Fees Paid by AppBcant(Initial) BLDG ELECT PLUM MEC.
CDU)s I or - 07 ❑ ❑ ❑
LICPNSEU CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
Ill aR dao I am fie ° n I'rowi`:"° r 9 rcnmrrca. . JOB DESCRIPTION
1y�j0p with garct,] Nll ofllivuloitJufth Bunirca Jmy limruc is PERMIT ISSUANCE R SID NTIA -
FF full f«tt vol cR _ (s
CwF m' T' El Mimi. ❑KRCIIEN Rf:MOUI:L
aF.U U Ucc y{ les tic.N
NZW Dac�C«ursclw APPLIANCES-RESIDENTIAL - ❑ADDTDON ❑PLUMBING RE-PIPE
pN ARCHITi!CTSIJECLV []MULTI-UNIT ❑STRUCHURAL
F- I'ANI!I ti
ZprijZ TUldaatnnJ my pWn.fall Muse)as public MODIf•IGTION
, UP TO Zito
l- 1-arnscd Profs.wood 201-l"AMPS ❑INTERIOR ❑CHIMNEY REPAIR
�yE OWNER-BUILDER DECLARATION 301-IW0AMP5 IMPROVEMENT
y C W 6 I hereby affirm Thal I.cacmp Bom the Comnelnr'n License law f«the OVER 1000 AMPS ❑BATH RFMODEIIREPAIR ❑DEMOLITION
x 3 a U fdlowing«asw.(Semon 7031,5,Husirra.nd Profession,Cole:Any city or county SIGNS ELECTRICAL ❑OTHER
LLl LL a which rewi..pmsnit m corn,, 1,alta,i.,nn,dcmnnrh, or rclv;r ear atncwle
O lai,c mit,ixsuanc,,Wm rryuises the applic.nl for wch pcnrduo Glc e.igtrd natatrca
'F-' N SPECIAL CIRCUITMISC.
fy�} dwhe is....g M —o-nncaution ....f lvi Ecu oflheC-R.,irror'otalPnse L.w(Cbepa9
IL (cam III excnoth ScctiouJand ltrials nor fll M:Cgii]exmp Prr.Any violation
TEMP.METER OR POLE INST. COMMERCIAL
IL a tha k u csemq thcrtfmn.dl Ik buffs for the allegW caanpion.Any violatien of
TION
Sation 70313b lirnnl for ❑TEWBLDG/ADDRION ❑FOODS RVI
y any opp prnnit whjnis the opplimnl to oc'ivil perelty of N)WEH DEVICES
F Z>N•
not 1'O1e wnEvc hulxlrN Milers(5300). ❑TENA,YT ❑FOODSERVICE
fSG C] SWIMMING POOL ELECTRIC IMPROVEMF
I,uow"cr afthe pgrny,amy empnyas will wages mtheir sole compensntiun, M
will do the w«t,awl the srsuctme is nm irucc M or oli for W,lSa.B)f•i.Iluniltca OTHER
6 .rod Pmfu.i.Cot The C«unclers Lice.law dues nod apply to m owrr of OUTLETS-SWITCHES-FIXTURES
pre my who boulder cr,co,v tbcrtnn,end who docs wch wart Mmol(ur tnought
W.owo employes,pmvided that.such impoverrcnt.rt not iluendal or off d f« NEW RESIDENTIAL EIECIR SQ FT
ada.if,howevernle huldingorimmovement ie old within orc year of compleiion.the SQ.FT MOORA EA SSQ.FT.
Iter-builJerwill lave lhebuN ofpwu9,hathcdid not buildwilltpmve f«ptr- y
pont of sled. y .��
1,m nwner 11 the p 7fF,am Ms w ndy crullmting will:)analoo.ctan i- TOTAL:
conurum
the pmjat(Ser.]DLI,Bu.ircss eM Pro(ession.Code:)The ConwnoYs Li-
mareLow Joolmlepplymenowncrofpmpmywho huill-uimpawu thereon,nW QTY. PLUMBING PERMIT FEE � � 171996
who s9rllr.maf«.whfaojms withamurxt.,h,)list: d puevua m Ik Coor.ocn
Leanne law. PERMH ISSUANCE
(] lamexempt cook'! ,B&PCfw thiorrawn �!.� .Ir VUrLhil Hs.(1
ALTER-DRAIN&VENT'-WATER(II)
Owner Ute VALUA'If(lI)
EINSATIWrnunc, Cch,cf, .,..,if
HACK IBAW PROTECT.DEVICE
I hcrcby efOmt uMcr Cc i fie fperj,or wa of t If-i fra,Wor omt dotCour O O
�.1ion. earl iniadll fine It Sn cnocf Mo[ he Lar rColt-„vont«W6,.Corgrn DRAINS-FLOOR,RSJ(M,AREA.COND.
ration,u provided f«M1y Seninn J](p M the hMo CMe,f«tie perGmwnce of tie RIGS TYPE CONS'T'RUCTION
west for which this p it is Icua FIXTURES-PER TRAP
EI 1 b.vc.rd will rotation.Wo.tcr'n Cour reunion In, ...u rcquirtd by Satin,
t]Ip of theI borCuic,fwthc no taa Ifthew«tf«whicbN itis' GAS-EA'.SYSTEM-I INC,4 OUTLETS OCC.GROUP APN
My Ww 1 and Policy n -
Cmdm. tPotiry Nu.: GAS-BA.SYSTEM-OVER 4(EAI
CH P E OF COMPENSATION
I N FROM WORKERS' GREASGINDUSTRL.WASTE INTERCEPTOR
COMPENSATION INSUNANCIi BUILDING DIVISION FEES
(This.auun rcNlull Mcanplclai if the permit isf«me huMmlddlan(SI W) GRFASP,TRAP
«leu') IEANCHECK FEF,
1 ecnity Iahotcr in Ne an,no nanee ofthe wort f«which this pemdt u isual,l July
nr employ.ny perwn uatry l®nIn-rm.s to bccome.wbjar to tM WMai Cnmprn- SEWER-SANITARY-STORM PA,NIO FT. 11.'IJtGY FEE
Z mite"..fCalifomi. Darc
Z O A Iwai WATER fIEATF.R W/VENT/ELECIR
IT GRADING FEE
V] NOTICE TOAPPLICANT.IL aha making This Crniacnte of ILempwlJ inn,you dtWATER SYSTIiM/IREATING
F 5 bcorm.ubjccl to the Wortef.C«"p,renu. ooci.ion,of the Wbor Cute,twit naw SOILS FEE
{agl forthwith corrlply with wch orwisi.or thi.permil shill he hrn lb,v . WATER SERVICE
Q
'U
CONSTRUCTION LENDING AGENCY Z NEW RESIDGYIIALPLMB. SQ.IT. PAID
T..10 It,
tmthattMrtiii, m(.lucliun Coding agency fes the perfwnna«eof 1)e¢ RaeiplN
� � the wswt T«whrh Thu permit is iuoeJ ISa.3097,Civ.G)
`U 4ucl Nems
U TOTAL,
Unticls Ad TOTAL :
U2 I crnify aw I have read this:trplic.ti«I.,d stere that the aMve ilJo,ation i. BUILDING FEE
TA corn,1 i agree to esanply with all city arm ewnty ordinances anal sa¢laws muting to QTY. MECHANICAL PERMIT FEE
V Z WiWItsL;conNr«Iion,.M hereby auth«iu rcpcxnwive ofthiscity tomtu wort c SEISMICFEE
above na,odocM properly fes iroMclkut W rpises.
(We).gm to save,iMemnify and keep haornu v the City MCupcninn a tinx PERMIT ISSUANCE ELECTNIC FEE
liabililin,jutlgmenls,cansaM uprn es which ltayineny.,accrueageinstuid City ALTER OR ADD TO MUCH.
It,mnsy«ncch g
of training of this'caret. PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIN HANDLING ON”(TO 10,"CTM)
SOURCE REGULATIONS. MECHANICAL FEE
AIR HANDLING UNIT(OVER 10.(MM)CFM) CONSTRUCTION TAX
Sz,calum ofApplk.rmCootr.ct« Dvc EXHAUST HOOD(W)DUC , HOUSING MITIGATION FEE
HAYARDOUS MATERIALS DISCLOSURE
Will the epplimnl urfwurt building wmu,nl,,.or handle bctardwslmscn.1 HEATING UNIT(TO IM."BTU)
as den 1 by the CLlrrtisu Municipal Code,Clupa 9.12..nd Ile Health and Safmy
CMc,S,clion 25533ro)1 HEATING UNH(OVER I(MI.IM3D BTI,
CJ Yu C]No
VENTILATION PAN S INOLE RESID) PAID
W II th a littnl w rmum builJin Dntc Recd,M
pp g by In,nluse.Air rm«dMatowhich BOILER-COMP(3HPOR 100,00OBTU)
it hmardrm..v mnwldlwu e.dc(I 1 by the Nay Area Air Quality Mamgemcnl
DLWcff TOTAL:
E]W, N. BOILER-COMP(OVER 100,000 BTU)
I hal Ird tk h.audous mvcliala re 'Tatra. Mer AIR CONDITIONER ISSUANCE DATE
FI t]apter6.95NJrGli-
fwnie HI-aIt�,P Safay t, Section, 505 35533 a�i 2153J.I unJClxnarW IMC if the NEW RESIDENTIAL MECH. SQ.FT.
huiWing da I ocwerElf eves IpenwhiRl- f IK�ee�µn
1) a(Re rsp 'c moa hen cof.Crnifrem of y.
(Tamer✓«authmi v gent Dete TOT,
ISSUED BY.
OFFICE