29277 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPE RTINO BUILDING-ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATTONIPERMIT PLUMBING-MECHANICAL 29277
BUILDING PROJECT IUENTIPICATION
BUILDING ADDRESS: SANITARY NO. APPLICAATTTIO'NSUHMfRALDATE
OW ;S NAME: , PIIOM_ C R'. NAME LIC NO:
NEC CONTROL N
R-H TiCTIENGINEER: LIC NO: AD)R 'S: ♦ L, IDG
CONTACT: PHONE BNLUING PGRMIT INFO
❑ Caluvltant I m Paid by Applicant(Initial) BL ELECT PLUP MECH
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
I hereby aTrm that I am leW enunder prmisims of Cbapmr 9lcommeming JOB DESCRIPTION
full
]000)of Divl.lmJof We Huaiwsmad Professitm Codc,erW mylinmeis
in full font sad if PERMIT ISSUANCE RESIDENTIAL
QVj Lire Elm Lic.N ❑SFDWL CHEM REMODEL
�n<a I>ve��Connanor APPLIANCES �' ❑AUDITION PLUMBINGREPIPE
1--py ARCIITRiCI'S UF,CI ION PANELS ❑MULTI-UNIT ❑STRUCTURAL.
Z p n Z I urdmwad my plan,shall be used ns Public record, MODIFICATION
OZ-p UPTO200AMPS ❑INTERIOR C3 CHIMNEY REPAIR
r�F-'W Licensed Prmcxsional 201-1000gAtl'S IMPROVEMENT
a:tw OWNER-BUILDER DECLARATION Corm ON OVER 1000AMPS ❑BATH REMODEIJREPAIR El DEMOLITION
1 hereby eft Thu 1 1. exempt form 1W Cmlrns'tnlx License city
for the
xLl� L V following mmmmn.LSo From,t ]GLS,Huel eta trod Pmfessio,l Code:Any city«cs.rnry SIGNS ELECI'ItICAI. ❑OTHER
F�CtI3 0 FN' which msryun n e.abum cmwmn.alcor,improve,n erounit t«c a nir any atermere
e thatpoorli-is Iceuad pursuant
Mvilioiuruf«wchimnitrofkse Law(natement SPECIAL CIRCUITR.IISC.
�}
that Wislii.g with
puauam mNe pr Di,,,! 3 theoe Bc,i to(a License Lew(,luior Cot,)
0 lathe e-e-PIISenicausto9)of bcisi or tof he alegsinnaand Pmt A,to G. of TEMP.ME'IEN OR FX)LI?TMST. COMMERCIAL
a y o pf WI he u eaemq Berefmm ad Jc Ivsis f«do alleges]cxempim.Any violrim of
nXl ONEW /ADDITION ❑FOODSERVI
as noMOLITION
t m]GL56y any eed dollanfor apermit subject the.pplicmt macivil pmRy of POWE F ICES ❑777NANT FOOD SERVICE
y «v mmxe thnn Rue hundred obllvn(SNN)1.
C3< I.uowrcraf Jc
YC-.Q ❑ propeny.ormy<mplgeea uiN wegesu Nei(wleamp,wutkm. SWIMS L :I[CIRIC
IMPROVEMENT
will JoNcworksad t is fmidea LSec. ❑OTNFt
sand Conk:The Cotaum',License Las sl vply O -
a 3 -S
Pfopeny who Willa or improves thereon.W who deo wch won,himself or 1hmnugh
his own cmployccr,povidcd thm such impovcmcnts art rW imeMN or offered f« NEW REST E SQ ET.
oak.
If.however-,N,Wilding or impmnvemem scold within me year of cnmplaion, he SQ,FT.FDOR AREA ASQ.FT.
rear-Wilder will have the W Nen of posing Nal he did not build«impmvc for par- wGY
,o,e of side]
I,u owner of the property,am a clunively commedoe with l.,enred mmmxl«x m
comaun the pmjal(Sec.71114.Buaimu amt Profcuisw Code:)The CmtectNs Li- JOA/ t
erre law doc.not apply m on owner of popsy who Wpermention.dila or mention.and Ql'Y. PLUMBING MIT FEE AAf t/ n
wha contacts for such pm ecls with a umtmeugq rcmv d wmauam rer
to me Coman , A96
I] I om excmla under tics ,B&PC for thu reawm PERMIT ISSUANCE Coy
Ut L'ut.ttl I Nn
Uare ER
ALT -DRAIN&VENT-WATER(EA) VALUATION
Owrer
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTEGE DEVICE
miner
p
1 hereby a1Brm unmlry of Fer]u7 i e nine
following declmamionx:
]Ihnv<W will mustier eCrnifcuc MCsxurntlo rel(-Ivurtf«WMcnC«npcn- DRAINS-FLOOR,ROOF AREA.COND.
.Vllion,ns povidal for by S«miun 3700 of ft Lohse Code,f r the perfmnuse,of de STORIES TYPECONSIRUCIION
%o&for which this permit is ivuM. 17MURM-PER TRAP
M I have"will maintain Worker's Campensuion Inam trice an mryircd by Salim
3]1X1of,L-tart.Codi.I.,Neprfmaunsxof the work for which Nu pmruiuivunl. GAS-ES.SYSTEM-IINC4Our EL'S OCC.GROUP APN
ntr w«ttrx c«nlensadm Imurven comer amt rnlicy nninixr art:
Grim Policy No.: GAS-G.SYSO MOVER 4EA)
CERTIFICATE OF EXEMPTION FROM WORKERS' I
COMPENSATION INSURANCE? GREASP/INDU.STRI,WASTE INTERCFYTOR BUI DI IV 1
(Ilii.reds eeeJ nei bemmpleN iflhe perndt is f«arae trmxlcd"hoo,(51an)
orle. )I GREASF.TRAP PLANCHECKPF.E l
1 crnify pet n the tiny man emf Na w«41«whicM1 mhis permit it ixsu c,I.rhall
mlemplo SEWER-SANITARY-STORM EA.300 FT,
y any Lera•m in aDY man w v1 boa a aub'tt to the W'rxkmi Comps- ENERGY FEE
Z shins masa,of Color is Dulc L
O wAITJt HEATER WNLNT/E- -
z O NOTE GRADING
y NOTICETOAI'PLCANT:If,Co king his viso.0 I of ILasur Co, .yshould WATER SYS'ILM/IRGTING
haemo tomo m it Wu h is miom,or
pmv taw of the labor Code.you mesa SOILS LYE
0. Q f«NuiNcwtrylywithwrh proviaionam Nixpmnit Will Wdccmcd revotN. WATER SERVICE
5z CONSTRUCTION LENDINGAGENCY NEWREMDENUd-PLMB. SQ.ET. PAID
L) 0 I hereby afilrtn that Nm ei- a elion lcnsim,. nay for pMnmmame n( Due RecciptN
O f"t the wort for which this permits iaandl(See 3097.Civ.C.)
U Lerdm',N,me
TOTAL:
I.cndctA�r¢a
6. comfy tbu 1 base read Nis appBcvtion math tare that ON,about imdmmtion in BUILDING FE
to concct.l agree to cuniply with all bill mad cwmy mmall—and sue laws re)uing to QTY. MECHANICAL PERMIT FEE
I
U building con.tsctim,amt hertbyvuthoriec represenwivci of thio city to enwrnpn the L SEISMIC FEE `
above nmentoml pmpcity for m,pamm purports' PGRMIT ISSUANCE
(We)agrre lo.rave,indemnify mad n
keep M1anka Oe City of Cape..eguimt ELE.CTRICFEE
Ilabiliticx,judgmrenu,cost.and exlen.acr which may in any way accrue against said City
in ammaqucrce of the grainfog of this pemul. 'ALTER OR ADD TO MECH. PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,1100 CFM)
SCURCEREGULATIONS. MECHANICAL FEE r+
AIR HANDLING UNITiOVER 10,A)OCRE CONSTRUCIIONTAK
Sigmmreof Applicinot7nlraclor Dale EKHAUSIHOGD(WIDUCq NOOSING MITIGATION FEE
HA]ARIX)US MATERIALS DISCLOSURE
Will dm applicwl or fmure building«cvpam store urhanffebut Nnua metrial HEATING UNIT(TO 1110.000 BTU)
u Wined by the CoperOmar Mwmicipal Coda CTaper 9.12 and the Heahb and Safety
Coate,Section 255]2(W HEATING UNIT(OVER 209,0110 PTU)
L]Yes
FI No VITT LOTION FAN(SINGLE RFS ID) PAID
WE the Dame Revel,Or
applicara«fmwe MtilONg«cve]bayAequipmenl«dMOuraenew BQILEN-COMP LIKE OR IW."BTU)
mil hvardous yr rmlwmiwnw err dcfned by the Bay Ass Air Quality Muagcmrcm
istnct? TOTS
I]Yes ❑No BOILER-COMP(OVER 100,000BTU)
I hove rtW the artbus materiels AIR CON'DIIIONF.R
raryimnema under C.1 b.YS of the Call. ISSUANCE
form Bet cid Sxiom 25505.255th]and 255]4.I wdmumd Jest if mi
ldin d« cox sum I Sit 7W RISIUIT'TIAL MECH. SQ.IT.
g yvvtaw 1Mtit ie cri eY=mib'diry It redly th¢occupaa
oft rementswhi malF mer Io i.wmec oto,itifcate if aNparo,. -
\LL
Ow r«. No'+� egrnt IAm T PA
ISSUED BY
OFFICE