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S 1903 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY �+ CITY OF CUPER'I'INO BUILDING-RI.RCTRICAL ,V 1 fNO. 1903 BUILDING DIVISION APPLICATIONIPFRIMIT PLUMBINGMECHANICAL BUILDING PROJECT IDESTIFICATION' BUH,JI©ADDRI?SSSANITARY NO. APPLICATION SUBMIITAL LAE 1; NAME: LIC O: 7-2 3— 7 CONTROL 111 ? NI!GR; LIC AUU �S'. � ❑ O PHONE; BUILDING PtiHM1T INFO ❑ ComillfeBf Fadi Pi by Appli.t(Inifial) BLDG ELECT PLUMB MECH ER u.c 73 L.�- 4� 2-,- ❑ LICPNSI!D CON IRAM OR'S I)FCLARA'I'ItIN Q'I'1' ELECTRIC PERMIT FEE 1Mrcbydfmn1 i1am INcroscdankrprovision.of Cl Ver9(cm ing JOB DESCRIPTION Z th Scctiun7000),Iffb1mim 3 oftne tlnawee.ud Pmfeasiona Coati my lire is RESIDF_NTIAL: F�� I full form mdc q C PERMIT ISSUANCE y.W Y .J ❑SPDWL ❑KI'ICI!ENREMODEL Fd-U�j Licrnm Claus _ LicA APYhIANCF_S-RESIDEItT1AL ❑ADDITION ❑PLUMBING RE PIPIT ,,t<= Dale T"S DEna ARCHITI[CI'S DLChA A ON ❑MULTI-UNff ❑MODIFNRN. F,ptn PANUS MOUIFlCATION 7Otr-Z IutticrslanJ my plan shed to u.wd u,pumr mrxds OZ-O UPTO Z(0 AM11P5 ❑INTERIOR [I CHIMNEY REPAIR <-kkJ licensed Nufessi.nal Nit-10X0AMPS IMPROVEMENT E:]SWIMMING POOL'S J (IWNPR-BUILDER ULCLARAI'ION CY OVER IW)AMP$ ATH REMODE EPAIR ❑DEMOLITION IY=Q 1 hereby vtimt tial 1 1 exempt from the fn iwri Cc License law ec the �'�LU which r8n'm^n.(crwr,]o31 S,IWa1wI.ard,,(cameo Cute Am citYmmoi SIGNS IiLECfRICAI. ��HER 61r.F' Emrtoils ilsis .permit manstnat,mar,impnwq Et-co". fie I Sirany sl emcn, prior to its iawirwe,uw rtyuitn Be yrpl'ranlfu such pmnit to flcasigrcd uatetrcnt SPECIAI.CINCUITIMISC. fly,,, Nm Mia liccnacJlwsuamOO lM pruviaitmnoflle Cmtrectula license Lew(Cheltcr4 C y.QA bar Iracing with Serefurn"l.f f rd@e Hted I., iti l4.hwy ihromor TB M CN OR IY)LL INST. COMMERCIAL: Ya]i o C�C See rr is exempt zany aPm W the buns for be,w, the cacmryiun.a 6 vi1111 of El NEW BLDG/ADDff10N ❑DI1.10LIT10N �mN Scclim]OJISby any yryiicant forapmant wbjecta the epplicvnl l.acivil penally of W ,VICES ❑TINANT ❑FOOD SERVICE: mt more Then rive hundred dollen'D5BD). F Z N OTHER I:MENT =d � l.¢s uwxntl'thcpnipcny.orntYcmPmYeeawilh wvgdm0alrwlcrnmpcmareat, SWIMMING LELIiCTRIC S will do tM ssuk,ad Be..law isnot intenled wMlcld forule(Sec.70W.Buenas ❑OTHER F W 3 candpro Pmrcuiolc Civic:TM int,reves th raw.Emote IS.does rat apply m an tnvtwr of OlD1JTS-SW -FlXNRFS his cast y wn.huies.ox I,iifi t-Iniad who d.cv each int added or H redkb his own eiilin,buildJd tful amen impmvemd me MI iyearof or ulfernl Iia NEW NYSIIlINf1AL H SQ FT. .k.if,hoaevcq Be builJinBaimlatn'rnrnl is sold within the y^,..frnmpleiom,tM SQ.FT.ILtbR AREAS/SQ.14. er-huilder will hare the Purim of peeving Ihm he did nut Iatild or ingmwc for pnr- ❑L.s dote M IM Se,70,em eacltrsi I crow"i ing wiN Ikemtd mnaanoas - I" r ate La des nor (Sec.]ars,owner td led 1'taw who has a,or TLe C.nherect a Li- mmeWwJuean�tLpplyotanownernfprnpenywhuhullda or lmpwves mereon wJ 12l'Y. I'IAA181NG PF,RMIT FEF ubosurn sfor amen project.withvcuervamori licent pnsuam Imthe Conuanms Licttmm law. PfRSi rISSUANCE' O � l mncscmia matt See. ,H&PC Ba this reason f ALTER-DRAIN&VIENf-WATER(EA) VALUATION O v Ie WOR K IIR5 COM PIINSA'I'ION FACE RATION BAC K I7LOW PROI ECRL UFVICH 9 I"by affirm under PetulD of perjury ere of Je fdlravin,dcclamtiure: C I Neve ad will muntvn v Cenifirate.E conaem w mdf-insert for W'orker`s Cmlpen- DRAINS-FLOOR,ROOF ARIA,GOND. S'I' RIES TYPH COMM UCfION satim,as pati&d bw by Scethn 37W of the Lai Coda,for the roof ofr,mw of the work Ior which this permit is issued. FI%'NRFS-IEIR TRA' ❑I lute and will maintain Worker`s Compenwwn Inaumi at,irwim ed by Seeman 3710.1 tMLhor❑dc,for the perGmnaocc.ftM work for which this prone n loud. GAS-P.SYSI'LK1-I INC.40U=S OCC.GROUP APES My Won t npcnwtii tlnsimmee cerrierrand Policy t Carrico YMiry Nu: GAS-EA.SYSTEM-OVER 4(EA) CER FlGTL OI'1!KINvrioN PHONE W KERS' C.OMMhSAI'[ON INSUkANC. CRHASBSRSDUSTRI,WASTE:WE ERCEPfOR BUILDING DIVISION FT;FS (Missmi.nevirat hecnmpletd ifine pttmit is foor re hnrdrddolWrs(S 100) GRI:SETRAP u leu.l PIANCHECK FEL I rentify l hm In the ertommnre ofthe word for which this permit IS rl.l Shull SEWER-SAN ITARY-STURM UA.20017 - n I employ any R'rtt'n in any macer w us m Raame subject to the Woxken'Coxnpen- ENERGY PIPE O Z smitm Lams.(Celifwnu.Dole WATER HFJTF.R WNINDEIJ:LTR GRADING Fl;l: Applicvnl (q NOTICE TO APILICANP IT,aOcr nwWnr this Cemiicate M liter ioq You shnulJ WATER SYS1 ENMESHING hewo a aab) ,to IM Worker's CrmycmmiaSt pwviswue MIM ISIber Cnk,)aa nue SOILS FEE fuMwith comply with ouch provisions or this Permit Nall he&emd rcnAd. WAIT14 SERVICE MS CONSTRUCTION LENDING AGENCY NEW RFSIDI!M'IA1,Pi-i SQ,IT, PAID V 0 I hemLYelfml Hart here it.ctmumctiom lerdinevgenry for the perfei of 1 Receipll the work for which this(anvil is issued!(.Az.31Y)1,Civ.C.) F" IAmtkr's Norte TOTAL: a 1cd Arkari T BUILDING I 1 certify that I hast,read This It'hcxuow nM sate Incl the nhovc infomtotian ie N corri I agree to cont with of city and county omimani and sate laws reducing 1. QTY. MECHANICAL PERMIT FEE V Z haidirtg cmaUarlkn.and Faebyvutbmia tereserm ives oflhi.cilylnenterti be JEISMIC above nentionN la.leny Ga inspection purry+cs. PERMIT'ISSUANCE! - - (We)egrta m i indemnify std lacp hem ww the City of Cupemos,against IiLIiCIAIC Ilii$ Iiebilitin.jWBmene�mat,sod eapenaes whichmayinanywayaccruevgdnus City f I. DEIN i fm 1 ALTI3R OR ADD TO MECH. 'G FF.E gran go I)tvi O 171! IATIO I' 'IJS 'U WIL1 )MIRY WI'fl{ql.h NON-IK>INT AIH IIANULING UNIT('IU IILUXICIM) / MECIIANICALFEE OL1l'CI! KATION. AIR HANDLING UNIT(OVER K."CPMI ,coNsTRUCIION TAX Signature of Applicant/( t Ilam IIXHAUST HOOD GVd)UCI) HOUSING MITIGATION Fill H1 RDOUS MATERIALS DPiaf1-OSURI! Will tMep,ficum or lumne build ng oacupanumtc or hemle monokua nm¢rial HEeA'fING UNIT TO 100.0I0 RTU) an dctimrl by me Cupulini Munkipal Crile,Chapter 9,12•end de Health atm Sawdy Cade.Seetirn 25532fa)? HLATING UNIT(OVER 100,000 BTU) Yca a VGNI'II.AI'ION PAN(SINGhIiNLS1U) PAID1). Rae BE Will IM applicant or more building occvlunt use equipment m&vim which BOILER-COMP(111P OR 100i BTU) emil haiendatn air rnnaminam s as defined by the Bay At.Air Quality Management 'rD Ilietrid? BOILER-COMP(OVER I100,000BTU) [:J Y, AIR CONDITIONER I Mvc raid tM hna lariule gitirtimno mtks Chnlntt L.95 of IM CJi. ISSUANCE DATIi huinfir,clue,cone mrrtmdy In E.that it n5 my3tryamiblit)_m hurt theth—ficam NEW NESIULNOALMI:CH. SQ.FT. r'I /J oI tM 4 nn which .y tom of a Crn lltc t fOe (/ (MrecT—or laE �Z��are TOTAL ssucD BY OFFICE