S 3895 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPE.RTINO BUILDING-ELECTRICAL IERMTr NO.
BUIL'IS(:DIVISION APPLICATION/PERMIT PLUMBING�NF,CHANICAL
BUILDING PROJECT IDENTIFICATION S 3895
BUILDING ADDRESS'. SANITARY NO. APPLICATION SUBMITTAL DATE
Z o A- -7315-Ya 7 -99
OWNS PI{O CONIKACOR'S+NAME' WC NO'.
/O ✓ W S.S NIC CONTROL
ARCHTt!Cf/CNGINFFA: LIC N6 ADDRESS: ❑ Q u (�
CONTACT: PHONE BUILDING PERMIT INFO
/y( / /� �S ❑ Co�S 1-1 Fac Paid by Applk l:(Inlet) BIL�1H(� El EECTT PLUMB MECH
(� ` LJ LJ ❑ ❑
LICENSED CONTRACTOR'S UF.CIARATION QTY ELECTRIC PERMIT FEE
I hereby affirm that I mer limmsed ander provisions of Cla,F r 9 Bommenemg JOB DESCRIPTION
{O�Z th Sfmnll)(Hppd I),,aan3aI`bc theme., ad Prefesmon,Cadn,oadmy lannm is RESIDENTIAL-
in
ESIDENTIAL
FOO nl lull fume and ellen. Z 'I PERMIT ISSUANCE O
C W F IJLie , 3� S (� ❑SFDWL ❑KITCHEN REMODEL
�¢a Tem Class APPLIANCF_S-RESIDFNIIAL El ADDITION ❑PLUMBING RIi-PIPE
F->v, ARCHITECTS DECLARATION PANELS OMULTI-UNIT ❑STRUCTURAL
Z O N lermara
Z I ural my plana shall be used purt
in blic caeH MODIFICATION
OZ—rz UFTO200AMP5 [DINfERIOR El CHIMNEY RI?PAIR
at LiccnvW Veofcssioorl 201-1(U)AMN IMPROVEMENT
OWNER-BUILDER DECLARATION ❑$WIMMLNGPOOfS
6 1 hereby affirm Rut 1 am eaemp from the Conuactar's Licenme Law for the OVER 1000AMPS ❑BATH REMODU REPAIR ❑DEMOLTION
K O U following mamm.(Salam 7031.5.Burircss and Nok sufink:nk:Any city m county SIGNS ELECIWCAL OTHER
3d LL which racier,a rcranit to emomme t.¢Ite,in crooe.dcmoleh,or tepuir any mrumurt
1�-u'Da primmra SPECIALCIRCUT/MISC.
fly thm4 is Been"pmntum ,Beprovisions M the Conuxmr's license 1aw(Cltspm9
W1'p0 fcvmtmcrcingwith.cctirn7IFNporlNvirim3ofthe Boircxaanl PralcaionsC(,c)or TEMP.METER OR POLE INST. GDMMERGIAL
110�f Fiat he is eaamp Brcrefmcl rte m abads for the alleyW em,rop ern.Any violminn of ElC NEW BUI ADDTION E)DEMOLTION
x Section by any.,]it.f« kron
a e,subjects Jr eppM licama,a civil peral POWER DEVICES
LLT=rte OV� ❑ R [3 FOOD SERVICE
ZG m onIh
nte un f ve Inherited rk9lers(55(1(1)' IMPROVEMENT
�1... wiLas ,Fie pupcmom evwithwngnmeiwile nmtpenwSWIMMING%K)L ELECTRIC
willa Fate.mlab themruchim uea interaMoroBertJ fmvack(See. Busnes, BOTHER
W vrrd Pmfessinna Col e:The Cmaatasi lana)w lawdon rot Aha toll rtrouof t3lITJTS-SWITCHES-FIXTURES
13— properry wMt nand,rr improves thcram,and who Jt„a.wan wick himm f err trough
his own empnyees.pm,iceo that such improvements art no,interai or mlernl tar NEW RESIDE CTR SQ ET.
sale If,hoaeer.the hulking el imprmemem is Fold within ore year of completion,the SQ.Fr.FLOOR AREA TJSQ,ET
Inra-W iltier will Wvc t c nurc en of han,inr that be dad ar Wild or imlouve for pua-
Pee o sa
1,as owrcr of the ro,,oy,0,1 nm eac]u Fuad mnfmaii ns with li The
contrmru, m TOTAL:
conuwct the projaF ISa.)I W,Busirrns sed Rnfesavm Cuk:l The CumacFe:s la- 7
,ease Lawm—mlalmlyman owner of prrye,nr wit hunrL Brimprevest,><an.mal QTY. PLUMBING P FEE
who m.,,f«such po,*.w iffi rel uroctoFts)Iiansed pu.to the Conuactors /0,7 /��
Lian�e law. PeRMrr LssuANc
p lam caemp an.krsa. ,Bsrcmrni,rta.�,n
Owner Uwe ALTER-DEAINAVENT-WA I VALUATION
WORKERS COMPENSATION DrCLARATION BACK ROW PROLE H V U
I hercbyvlGnn under penoltyof penury omnfthe fol Lowing Jee]arationa: QQQ
C] Iheve enJwJlnudnminel'cnificweofC,mecnlmwlf-iruure for H'urler's CanFpen- DRAINS-FLUOR.R(IOF.AREA, ND. I yToglFs TYPE CONS RUCTION
ants,as I ovidd fm by Sation 3)0(1 of the Lala Cao,for the perfrcmucx of de, N1
work fee which the,prnnn in joamd. FIXTURES-PER TRAPFl /
I have and will nuitomn Worker,C,,a,,awion hnwrame,av rr,,jicy 14 jlc lin GAS-E:A.SYSTEM-I INC.d OITLEfS !/
3Tl(1 of nc Wim Cork, heperfmmurcc oftyL work fin, t�nA
My _ r�/1/ aYf . he tCC���GROUP APN
Currier.— r cwraPo my Nn.: GAS-EA.SYSTEM-OVER4HiM
63
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GRFASFIINUUSTRL WASTE WTERCEI?OR
BUILDING DIVISION FEES
(Thio section ned rot kcnmpldN iflhrnrc
cpnit is far ahurdrtJd
J lms(5100) GREASETRAP
u 1,o.)u.) PLA SCK F6E (1 L
I cenifytWFin Je perf«nune ufthewM(rr which thio permit ivissuW,Is1uB SEWER-SANITARY-RORIMEA.300 Ff. I l
tun,employ any Person n any nmener n ear to became,subject to the W'arl,i Com,,,, EMERGE'FEE a 4
C) satim lawn or Celifomiv.Data WA UIR HEATER WIVE NI'RiLECTR �
Z O Applicant GRADING FEE
N NOTICE TO APPLICANT:If,after mat thu Certificate of E.sempian,you,h old WATER SYSTEM/TREATING
a ? besot,abject to the Wore%CurFpemmim provisions of the Lahr,Curie,yea mum SOILS
.� fon hwith comply with such provimona or chin Fermi[shall W rlecmed revol.ed. WAI'Fk SERVICE
a � Ica
7Z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL lit My FT PAID OS
I..) O I thereby affirm that from,k ricoos0umim leadin,,ene,terve perfomumce of lute Rcaipl f
O .. the wad.tar which this permit is issted(Sc.309).Co,C.)
f Ltmi Name TOTAL-:
V LeMe',Address TOTAL:
1 cenlfy tat I have rtvA nln applicnlinn enA stone nw ho nbove'mfirrwlion In BUILDI FEE /V/, L)Q
(A wrrtct,I agree Fo comply win all city arse ersaoty on inanc,unit vie laver mlmink m QTY. MECHANICAL PERMIT FEE `
V Z buildingcowmunimianl hxabyawM1miss reprermutivn of thmcity menleaulrm the SEISM( FEE
eWve-mentioned prupeny for im,,r oan puRuves. PERMI'I'ISSIIANCF, P,LE IC IIiE
(We)egos dmnmfy m owe,mmol kelp M1omJ,v 0e,City of Culc�nino egvinm
I uhilithe,judgne,nu,costs mxl espmves which may in any way aconic a,loiror said City
in romegerce of the goeting MtlJsprnnit. AL TLR OR ADD TO MECFI.
PLUMB[N E
NT
APRICAUNDER DS AND ILI, O LY WTI(ALL NON-POINT AIR HANDLING UNT(ID 10.0(MCFM) MECHANICAL E
SOURCE REGUL //
6-8—Y9 AIR FTANDLINGUNIT(OVER IO,IUDF]FST) CONSTRUCTION TAX
Signamteuf App] imarmm But, EXHAUST HOOD(W(DUCT) HOUSING MITIGATION FEB
HAZARDOUS M RIALS DISCLOSURE.
WLl the apPlicenFmfuturc building occvpmit stmt or haMkM1arvdoiu wFcrid HEATING UNIT(TO 100,fgp BTU)
as defined by lk Cupcnino Municipal Cole,Cltaper 9.12,oral fh<Health end Safety
Grk,Section 25532(a)! HEATING UNIT(OVER H)0,000 BTU)
❑Yes ❑No VENTILATION EAN(SINGLE RESIII) PAID
Will the app]icart or future bui]dlog occupant um gn,s rent or]cakes which Dom Receipt o O
enilF haewuus ma mntmmwnts es detirW by do Bay Arta Air taulky M.,enent BOILER-COMP(THE OR 100.000 BTU7
Doonim^ TOTAL:
❑Ya F7 No BOILER-COMP(OVER 100,000 BTU)
1 five nal doe bacont nuerialn AIR CONDITIONER
meyuirtneme series Chaprr b 95 of hat ISSUANCE DATE
funis Hulth A Sefcry Code,.,, I 13 05,255]3 amt 23511.1 uMeamerd tae if the NEN'RISIDEM'IAL MECII. sQ.Ef. 7--
' WikOng desnucyyenlTyq�Rtulen of it- my 2rvpm,ibJitymmFll'yllcaeupvnl
of nc re,aramnas w Ls or to.M'e Cenifiveof yjm
Owre,ra authoriac agent bbl}te TOTAL: ISSUED BY:,lI�1Y�70
OFFICE