S 0771 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CENE
UPE RTINO BUILDING.-ELECTRICAL PERMIT No.
G.DIVISION APPLICATION/PERMIT PLUMBING.-MECHANICAL S 0771
.BUILDING PROj ECT IDENTIFICATION
BDRESS: SANITARY NO. AYPLICAUUN SUBMI'I'IAL DATE:
Ge� �PiZ.w-e� -L ONAM[ YHUNP' CONTRACTOR'S NAME LIC NO:
�. �_.1� D WC C(O'M�HOLN
Y:TI 'ECT/FNCINEER: I.W NO: \ ADDRESS: ❑ 00 6�`
qA7t
7E.
: • PUO E: BUILDING PEERNIITTINFO
�,,, L ik -B$7 ❑ GonsWlanl Fee Ped 6y Appli and(Initial) El.li MB CH
'� ��
I,ICI?NSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT FEE
mhy dfirin mar I an licca d miler pnwamns ofch:IMcr 9(aalalmacing JOB DESCRIPTION
]00)of Division Jol'the Busiltnnand PafesilOm Cadc-mil lay llcenw is PERMIT ISSUANCE.
and effect. WI. El KITCHEN REMODEL
a 11cY gPPLIANCISS-RESIDINHAL ADDITION ❑PLUMBING RE-PIPE
Gnwna
ARCI 11'1'ECGS DFCIARATION PANELS ❑MULTI-UNIT ❑MODIFIVRAO
oz
Z lundcosual DIY PhmN SM1nllhausd ar plJdic nsasr6 UP T02(MIAMPS A10UIFICA'IION
❑INTERIOR ❑CHIMNEY REPAIR
1-1!+F-� Liantel Pofe Conal 201 Hal IMPROVEMENT [3SWIMMING LOUIS
�'f-�] OWNI?R-11UILDER DECLARATION OVER HXIO AMPS ❑BATH RalODFAJREPAIR ❑DEMOLITION
ty] I hcmhy affna that I am enctnpt hunt Ik Contraanr'n Liccnsn I-aw fortha
K O 6 V following teawo.(,Scrum 9031 1,Ifmioa.nal Ptnlnciore Cada:Any city or coany SIG,V'S GLIiCTR'CAI. ❑U'I IIiR
3 LL�Q which macron a Permit to emNmet,alter,imTmx,demdiNR a rtlair any-acture
F-LLvlO.] prim In it,issuame.dw mquirts the applkaX(a tach Permit to filcesigad slwctrlrnt SPECIAL.CIRCUIT/MISC.
Ety that he is liccnned parr-and to the Innoaa of tk Comorwnh l.iernu low Wham"9 OMMER IA
Ixp7 (ammna:ming.WiScliOn IlXppd 1)hision3if lk Buninc,s and Pmfcssiona CoOlc)rc TEMP.METIER OR POLI,INS .
d a C that he H esemp tharefa m onb,tori,for the alleged c-ruprion.Any viontran of ❑NI?W BLDG/ADDITION
❑UIiM01,I'I'ION'
X SoLL Section 90315 by myapplicam fa•person sabjanv lk gjlicenl to o civil Penalty of POWER DEVICES 0TENANrr ❑ROOD SERVICE
FZ_Y htmmethw five huMrd Mi.(SY10). IMPROVIESIENT
4 ❑ I,as owmrofok progeny.or my emploryms coot wain.'heir wle com,a,rodim. SWI MMI NG POOL ELECTRIC El OTHER
t aG will do ole work.and thu slmcture it non ant akd aoRcmd rr adc(Sm.9IIYf.Busim'es
Lami I rorc ,ons Co,,,..ole COmtmctoh Lawn,e Law dos,not apply to an Owner of Ol1TIliTS-SWITCIIPS-IIXTURES
IosopenY who builds a impmvu tirmun,and wro rises wch w'rck hineclf or through NEW NESIDFMIAL I:I.ECTR SQ FT
his own employees-powiJW That such irtprmxnenu are as iacoded a offered for SQ.FT pCook AREA S/SQ.FT.
ok.IL howevo,tha building m imprnvrnrm iv sold within note yea of completion,the
ncrbudder will haw tk Nook n of proving lha k did not baidrc hnptovc Oepur- �� 60
on
oww of ecce).
I,es owner M Nc poopany,um esclusivaly Cormse ittg with licrn1. cwll ar,to _
Nnam tha pmjm LSec.1TU.Nusircu asod Psefrssions Codc:)'tor C-l—a's V-
lona law due.nm apply to en owmof Pnpl'nYwro Wildsaimprovcstkmm.aM QT'. PLUMBING PERMIT FEE
wMO umtracu Iir.mcIt pnsjca,wllh a amaanod,)Iimvd puwam m tk Cmlowaor z
ELcmx law. PERN111'ISSUANCE
❑Lam esemptundm Sec. ,B&PC hr Oismawn
ALTER-URAN&V ENI'-WATER IEA) VALUATION
Q mr
Data 3q 0 391
O C PIiNSAT1UN DGCLANAT I), BACK FLOW PROTECT,DEVICE
�� Ih yot0mt order pcwlty o(perjuryam oflk lollow'ing Jeclamtinns:
Ihssc aro will ortatwmaCmilicau ofCm-an mrelf-inwrc fore Wahcr'xCmmpcn. DRAINS-FLOOR.RWP.AREA,CONT. STOftIF_ti TYPE CONSIHOCTION
-tat,m f,,vidd Or by Satial 37M a tk Labor Code,fa the peRomarce of the
work for which This permit is is-d. Fl%T11NLS-PER TRAP
+ [I I have load will nmintain Worker's G orfana ion Insamme,a,n4aiml by Section
{ 390the Code.fm aaa no Iffortof the work for "o""o"is "'ad INC. LI?TS
Ld laNr OCC,GROUP MIN
My worn N Canpcnutim lmurllnce ewniar and Policy number are: G SYS f VER
Casriear. Policy No.:
C,RTIIlCALOP EXEMPTION FROM WORKERS' GRPA5IJINDUSTRI.WA, HCEf'NR
COMPENSATION INSURANCE BUI ]SION FEES
TlhsxCr n:d mr .unnplwd iflk lmnitn fa ore huahcr QNlan lgll SgKAP
a krs.7 PIANCIILCK fE
Icmify tMtintk peRvmunce aftk walfawhich thinpmoit is Lawed.l shn SEWER-SANITARY-STOR 200 FT
retemploy anyp oro in any roamer w as to basnnc subjat to The Waken'Co. ENERGY EEE r
1 ,Z at.Litw,af CallLtmie.Data WATER HHATF,R WN113T/ELE ORATING IL.
f Applicant t
y NOTICE TO APPLICANT:IL after making Thu Cmifiate of IixcmptiOn,you shoal TREATING SOILS IEE j
besmnn subject titstk Wither.CongamaniOn Iewiucns Of the Labor Code.you mar
a � fanhwi0 coa lr withsmh provision,or this permit slug be Ok<nM rnekd. WATER SiDtV10E
Z CONti9'HUCI'[ON LENDING AGENCY NEW HILSIDEN'llAl.i'LMB. SQ.FT. PAID
I kmhy effiml Est thane is acOnawNrion lealingugemy forihe peHmwseeof D Nncip
V 0 tk work fa which this p.I is issued(Sec W.Co,C.) TOTAL:
ULcotdm's N.. L -
N-1 Larder's Addr. Bull FF
I certify that I have read Ihis up,hl.no,ad,twe Ictal IM a1nNc InBnwtioo 11
IA Crrect.l aorta at comply with all cityami army OreitaasN and ware lawn mlarng to QTY. MECHANICAL PERMIT FEE SE TC
V Z builJint conatrvction,vrd M1mchy awMnsc mprnaswwse Mthis city m[mR upon tk
.� ebove....dlnycrty fa inspection pmryrse+. PERMITISSUANCE ELL IC
(We)agree maeve,adamnify mod keep basnku the City of Cupanino against
Iimilaics.judglnena,cows and eapcnscs which nay in anyway acerae against Qid CityALTER OR AJD'TO MECH. PI, LANG FLB
in consequence of the training of this pmon.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDIJNG UNIT CTO 10.000 CFM) MEC NICAL FEE
URCE EGUTATIONS. JO
AIR HANDLING UNIT(OVER 10.(X111 CEN) CONSTRUCTION TAX
not fAppli"=^ arra. Uvc EXHAUST HOOD(WA)UCG HOUSING MITIGATIONFEE
I R SOUS MATERIALS DISCLOSURE
Will the applicant a fame luilding rccuperi wore Or hmdelwaM1xas matehiat HEATING UNIT TO 101.000 BTU)
a,defind by the Capeniro Municipal Cask,C aa,1).12,vol tha Health ami Safery
Cork,Scadoo 255321a)9 HEATING UNIT fUV1iH 100,000 H'TUI
' C3Yn ❑NnVENTILATION FAN IS I NGLE RUSH D) PAID
Dart, Reccl
WSII We applic a m(adore holdout m'urya a,e eaaiprcnt m davi which BOILER-COMP(3HP OR 100.1100 BTU)
B Lmkriax air s'ontaminunta as dcfnd by the Bey Area Air Quality Management
,aR BOILER-COMP(OVER 100,000Hl )
ED Yet, No
I have read the h+_ •-..s mvmals Iepureoaas under Ch pacr 6.95 nl Jr Cali- AR CONDCHONER ISSUANCE DATE
fania Health&Sabery Code,Saviour,25505,25533 mod 155M.1 mldcrwad that if 0e NEW N tHSIDFINTIAL MECH. SQ.14.
building docs nor eunm0y bate a term.INa it i,my oclicoiblity to mall'ThoIcculvin
of the oenimnrnu which must be mel poor m issuame ofa C'coihcate aTfk:curyocy.
OsvrlermwOOrimJ egrnt Data _ ISSUED BY:
OFFICE