28236 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF,CUPC'RTINO BUILDING ELECTRICAL PERMIT NO.
APPLICATIONIPERMIT PLUMBING-MKCHANICAI. 28236
BUILDING DIVISION BUILDING PROJKCI'IDENTIFICATION
BUILDING ADDRESS. SANITARY lL/ .D/% SANITARY NO. APPLICATION SUBMFTAL DATE!
71pF/I`r11V/LL_J Q LOTY
OWNERS A � PHONE 9QWRACPORSNAMk EJC NO: III{JV7J'(�-1
/ZjtbNIC CONTROLY
RCHITI /ENGIN .IC NO
Y. AD RESS: ❑
CONTACT: ^ / r I PlION12:
L QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
6?
r \ F,BLDG ELECT PLUMB M
PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECL&TION APPLIANCES-RESIDENTIAL DFS RI O
OK2 IhctcbYafMndtanl mnllmucd w4rprovkionsof Cha1ntt91avoamencingwith �`� ,I� DES
yO� fulltfaa'cl )efts%A Jof the Buaimav[W Profeaim.CoJde,reM mylia�ia in PANES �J U�,(�-��1�/! e
Fyly Liccse I V Us.N J� 3 D b UPTO2(XAMPS IfNM��I (J o�
h=y Dete 1�� IP0\ Comosfm Nrs tn.l ftSOI.HMOAMPS
>O~N� ARCHITECT'S DECIARATION OVER 000 AMPS SQ.FF.ILOORA S/SQ.Fr.
O aMttstend my dans shall he used m pubi rec«dv
SIGNS ELECTRICAL.
Qya.�J IJcrnscd Pmfcuioml
as Q OWNER-BsmrR fi tha,CRATION SPECIAL CIRNIT/MISC.
LL OaU I n, of(Se that 1 am esemq from the C u,iasm Co eii Any law co the
{D3LLra¢ followingrcanx roma,,7831.5, ".1nc,an"Pmfcamoli Cod ncIou city mcoanty TEMP.METER OR POLE INST.
which its apcnnit totsim,tfaefiner,Im am for such
crag a mrepairany zuroclux
esaummaot POWER DEVICES
ww<0 Iwinrb4 livawama,au gto the
Neovisiosof the Comnmdtb Lkase La awmuent
�KQp ilhon9(c hekncingu P,mvtion7 )oviriom of the the Business
l.iccnseesioos egtt
YtNy(o� 9(comnxnuing wish&etion]fgp)of Div'wnn3 of the llmircr and ltofxsiors Code) SWIMMING POOL ELF,CIRIC VALUATION
ul of M that he k exempt therefrom and dte bask For the allegd ncmptiom.Any n detico Of
tK1Section 7031.5 by my applicant far.penmitsotllwv t appliemt m a civil penally of �-ETS-SWRCHES-FlX'NRES n
F not more than fie hundrel dollar(1501). (� (/✓,
cd ❑ I,.sowruervnfdeprnpcmy,armysmplo w astlairsdecompe wsn, NEW RISIDIN"fLV.ELECIR SO.FT.
STORIES TYPECONU ON
d3— willdo the work.ard the fate's oss( «.]Dwu,
.Busin
and Profsss.Code: C t n ac drat not 1,'..'.awns,of
pmpemy wha build. ren odaesj�n rtIm aghhi.s
wn mployees.pmvi uchi cane/7p0 tarsale lL C.GROUP NES.UNITS
c
hmvevtt,the buiding«i mlvemem i.ssiJJyy ofcmn c ,theowmi-
nailderwilliat—the bard a fproving the h fel improve(«pmpo.¢o( T
TY. PLUMBING PERMIT FEE OOD_ZONE APN
❑ I,.a owneroect(Sc.70 mnesiness lycmeaco.. withlice The Coulmem Q
m. i the project(Sec.?(W0. nu ass ud ywhobiui CNsp Tia ih t e is
.lboco .lotssaw ot.pplytoanownenemsopeny whohui poutocam Love thOm.ne's PERMIT ISSUANCE /
whense, xu fm euchpmjecuwiNaeontraetufa)IicemNlx�numtto Ne Contnctora AL.ER-DRAIN&VHPyT-WATER(EA) FEE SUMMARY
Liccmc law.
❑ 1 am caempt under Sec. B&P C fm Nis rteron BACK FLOW PROTECT.DEVICE SANITARY Y OUTSIDE F N
Ow+rcr Datc DRAINS-FLOOR.ROOF,ARTS.COND. RECEIPT ft
1.� WORKMANC(3MFlNSATIONDECLARAI'ION SCHOOL TAX N
ay Thereby efRrm than a
l base. nifcurn
c a nmt to.elf ns. ,nm
Or. ufAR
cate of FlXTURFS-RJi.TRAP 'I Y
. Ontpmtntbe lrtuuvuamaemiOed cM'Y theemf(Sea.38W,Iab C.)which PK TLE N
cso,
m 0l na pSrrry _ q-4 GAS-HA.SYSTEM-I INC.4 OUTLETS in
PUIkyY emir, K 'S B D ISION FEES
EJ C�n 4,fy TL- Fca KJD GAS-GSYSTEM-0VER4(EA) I'IANCIIE
❑ .mired«my is hammy rmmknea.
❑ CenmOed copy is fled with de city inspection division. GRFAgEINDUSIRLWASIEINIERCEPT'OR GRADING
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP SOILS IIJ?
COMPENSATION INSURANCE
('fla.aectionnxzdmt becmnPlctM iftne permit kf««rc hundred dellen SIM) SEWER-SANITARY-STORM E.A.2WF-T. ENERGY FEE
m Ins.)
I cervi fy that in the perfo of the work for wnich chis permit Ot issued.I Jtel l WATER HEATER WIVENDElT
not employ any perm in my manner so n to bemnc subject b de Weamom' PAID
orPeruanioe lawn of Cdifomia Was WATER SYSTFJMOItEAl1NG Dns Mrs
O z, ^ N
f O NOI
TTICETO APPLICANT:If.after mcking this Confiner of Esemption,you shaud NEW RESIDENTIAL PLMB. SQ,FT. TOTAL
V1 become subj¢tb Ne Workela Com ematien povkiau of the Labor Cade.You man
fCMw'ith comply with such provi.ima rr this Permit shall be danxd trMcd. BUILDING FF.F. 2
ELI
0.. Q CONSTRUCTION LENDING AGENCY SEISMIC FEE
' Z) z Ihemby affirm d,o there is a conurvnion lending aCcm Too,he amend of
U O toe wank fur whim this Permit is ismed(Sm.909?,Civ.C.) I L ELFCIRIC FEE
Iso ,Nona
0 U [a ,Adds QTY. MECHANICAL PERMIT FEB
PLUMBING FF1i
U 1 anify that 1 have rend ibk appliention and sone mar ted eMve automation ation is
}' soused.lu tee to son I MECHANICAL FEE
6. g py withdlcityartl munry ordiwmn and nnslawe,uIsm the , PERMIT ISSUANCE
(F' Z dJldioYcmatruction,ertd htteby eat?wriranepunutmvn ofthia city turner,upon da CONSTRUCTIONI'AX
� z aMvert )a g.1.sate, for
and kesT,L.r. ALTER OR ADD TO MSCI I.
(We)egrx to save,indemnify and leery hnrNna the City Of Cupmimo against
IiatzOtin.jWgmmu,cosnaMeapcmn which may in any wy serve ogeiw acid City AIR HANDLING UNIT fT010,000 CFM)
e alto.sooting of this permit.
I AIR HANDLING UNIT(OVER IF."CFM)
Siguatwe of ASI+ VCommctm Date EXHAUST HOOD(W/DUCO
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 1 W.FM BTU) Date Rari1R Y
Well the applicant or future building occupant saace on handle hemrdcu mu esW
as defined by the Calaminn Municipal CWc.Chapter 9.12,and the Ilcalth and Safety HEATING I 1`17(OVER IIp,OW BTU) ITAL:
Code.Schon 25533(.)^
❑Y5 11 No VENALATION FAN(SINGLE RESID)
ISSUANCE DATE
Will de appllrvtt«future buildin rc<upant arc BOLLIR-COMI'(3HP OR IW,OIXI BTU)
g ryuipntrntmdevias which unit A,Q �fT�
hvaasdous
tax v eonwmi•.,us as by the My Ann Air Quality Marugeenrut BOILER-COMP(OVER Im,000 BTU)
Dromic?
13 yes E)No NEW RESIDEN'DAL MECIL SQ.FT.
I love read the Iuwdoua arem uth,o,timmems sods ObWer 6.95 Of the AUG 17 1995
Califomia Health&Safety C«Ic..cliomt 25505,25533 and 25534. I mldcaeoT that /�
if toe building doe nut cum,mly have aawt
t ,tbat it k m
my pasibility b bmfy rte 011 r Ur
acafam of Ilre mm mbe reduirm �ta whiust met prior to issuance of a Centircve of l.Uh'EI r
Qca�ncy.
Owm err aaN«ved.gcnt One TO ISSUEDBY:
' OFFICE