S 2762 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUTE RTINO Bull,DINC-ELECTRICAL 111IRMI'INo,
BUILDING DIVISION APPLICATION/PERMIT PLUMBING.-MECHANICAL S 2762
BUILDING PROJECT 111RRPIFICATTON L V
BUILDING ADDRESS: SANITARY NO, APPLICATION SIJBMMAL DATE
i� S GL-cJl.)vl� �, � - Le � A
OW'NER'S NAME: PBONp. CONTRACTOR'S NANIG' LIC NO.
/J• // �� NIC CON'IRIILM
iARCHTTECT/IT'GINPF.H: LIC NO: IG ADDRESS: ❑
CONTACT PHONE: BUILDING PHRNI IT INFO
❑ Cnnsultanl Firs Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
ED z , ❑ ❑
LICENSED COM'RACI OR S DECLARATION QTY ELECTRIC PERMIT FLE
I hereby arrr„I met I am lie, �irk pmvi:inn..of emal.R 9(emmmreing JOB DESCRIPTION
�DO with Section 71MM0ofl blivku J ofdte Husinlsemal Pori Cbsk.uW m)'It'.o RIRNIIT ISSUANCE R SIDS
FW- in full roccanl effect. ❑SFDWI, [IKITCHEN REMODEL
E
QU� Licersse Clans LicY APPLIANCE'-S-RESIDENTIAL ❑ADDITION ❑PLUMBING RE PIPE
F ZQW lyoc Coan.A-
F D H ARCHITECTS DECLARATION PANELS ❑MULTI-INR I]MOOD�'IC-URAL N
Z O'� l untkrstvnd mY Pl:m.c ehull ba tied os pttlk ranrds ' O
OZ-a
UPTO 200 AMPS LQ ❑INTERIOR ❑CHIMNEY REPAIR
GNF Lccnrsd Pof"imal 201-10(n AMPS IMPROVENIEX1' E]SWIMMING POOLS
OWNER-BUILDER DFCIARATIUN OVER 1000 AMPS El BATT REMODIRAEPAIR ❑DEMOLTHON
C C vt I M1creby affirm thin I oor asc at from the Con raelor'a License Law for Ohe
a' a U follming rearm.(.eeciam 7031.5,9usineas and ProRasiem Code:Any city aeeuny SIGNS ELECTRICAL El MITER
3 W y which requircs n Fenno to mnumc0 nitor,improve,demolirh,:r repair any ssmuure
E"I=�g fanocw its iawarce..l.wreyuires the"I"an farnrh pond fork asier ta,uc , SPECIAL CIRCUR/N11SC.
f r tial heisllcenw(ipumunmmlMpmvisioneorthn Cannrctnr'.Licen.mlaw(Chaptcr9
WC O COMMERCIAL
(ho be v ing with h.Cim 7660)to Division Jof,M Businu wad Pofeuiau Cadv)ar T:MP.MEI'I:R OR WIJ:INST
d y o C then M is csctnry therefrom and the Nwin far thu allcyed cxe nCfon.Any vi Af,a 1 of ❑yEW BLDG/ADUITIUN ❑DEMOLITION
W�H Satinn]0}L3 by eny applieentfaepemai,whle,b the apPlkvu tow civil prnahy of PoWER DEVICE
[]TENANT ❑PWOSERVICE
l r
nea,than five hundred do11;,(SNXB. IMPROVEMENT
FZQ tea❑ I.ex ox nrnf me TrapcnY,wmY emPE Ytta with xvgeamthrirsMe cumperevalimt. SWIMMING POOL ELECTRIC
will da the-als,nal dmamaum if notimcndedurnticmd far.1C(,Scc.71N4,Bnsircss El OTHER
Ia1 and Pmf¢cions Code:The CanaclCrf License law docs trot.,I,In an oanrr of OU'D.ETS-SWITCHES
-Fl%TURE
,sbrmy who M:ibds a improves Ihrnron,end who o r such weal himself or thmueM1
his own conoryees.IxovidaA Thal such impmventents arc not mteMal w nRennl fn NEW RESIDENTIAL FLEC R
.1C.If.hrwever,rh:Madding alnlPnwumenits sold wrhiroa-year ofcumFeflon.the SQ.FP.FLOOR AREA SISQ.IT'
an-r huildcr will have the burden M lensing mvl he did or hand a improve for pur-
mwofwlr.).
of the Fr tPri,,em Cadusiwly arnuneting with lice N cono.'s,In TOT L
r�(y�1
u6,ro,are project(Sec.71144,Busiawse mW Palf—all s CrWe:)The CaruradNe LT-
nscLaw dnes awl vpPly to an nwrrer of properly who hbild,or improves thenen.std QTY. PLUMBING PERMIT FEE
wMs cunwetn Ibr rushµojceu with o conrumgq IicenaM PuO,,.r m the Gruns,urs
Llccrnc law. I'YRMI'I'ISSUANCE?
1.cacmpt uNcr .H h PC for this rcawn
Owrcr _ ALTER-DRAIN Ne VENT-WATFR(110 VALUATION
DLe
W'ORKIiR'S COMPENSATION DFCIARN'IfIN BACK 14,OW Plol'ECL DEVICE
I thereby air a under awry of pnjury,arc M tk ow
folling dccWntixu:
I Rvc tud Is l l mwnwin n Cen r1cav of Convent to.rd l-inwm far wakcrs C.O,r- DRAINS-14.00R,ROOFI AREA.CON I), STORIES TY PE CONSTRUCTION
wham,as VmvidM for by Se rtwn 3700 of tar lahar Calc,for the Feck nwce of Be
veal,for which his permit is-art PIXTIIRIES-PER'rRAP
❑ 1 have rad will nu Wain Wirkcis Cnmpc¢svim Insumrre,os wa]Uirt by SCCoon
3700oftha Lahr Cask,forme penixaanttof]he work forwhidtthi,,{acorn is iwued. GAS-EA.SYSI'IW I IN'C.401TREIN OCC.GROUT' VA API
Nty waters Corafewmwa lmunrce tamer and Policy number ere:
Carries link,No: GAS-CA.SYS'DW OVER 4(PA)
CERTIFICATE OF EXEMPTION FROM WORKERS' CRI?ASIYINDUSTRL W'AS'IIiIMLRCIIPIUN
COMPENSATION INSURANCE BUILDING DIVISION FITS
This sectio need tet ecorriletcd mit iflhe Peris for.hanalredsNLvs(Sllpl GREASE:TRAP
or kw.l I'IANCHLCK FEE
I mtify,Main the perfam eatlhe-wl,for which oris prmdl is iswN,l shall SEWER-SANT -SfOR .''ENI Fr..
not....ploy troy Pimm in wry a amarm m to tenon.sahjCC,lu tho Waken'C.O,r- ENERGY 141E
0Z aim taxa a California.Daae WATER IIIALE }TA :NT .. GRADING FEE
z O Applicant
y NOTICETO APPLICANT.IL of,,making this Cmificuc of Hinear Liam,you sAvld WATER SYSTE AP An RTOTAL Solus FEE
Eccmr inbcci In the workers Comlrnvaliml provisions oflhe Lr rw Cade,yon rocs 1
11-011 is, 7
famxim comply with such pmwisianaamis lnmit shallhdeearcdsevokd. WATER SERVIC
d
CONSTRULTION LENDING AGENCY NEW RESIDENT PLMP. SQ 17R\N
UO 1hachy.ffima lout llem is aconWwticm lvnding agercy for Be,Perfotrrasr.:of p1 RettiptY
(•' the work for which thin pc.it is issuad(Sec.J(B],Civ.C.) LSV
O ' I<ndcra Samc TOTAL_[c ,Adhor1 cmifY tMl 1 have rcW this umlicatim anal war that tar above infinmaliam is NUILDIN(I, coma,.I egteeto mmMy with ell city and aaamy ordinonccsvnd sutC lows arl-arg to QTY. MFCI IANICAL PER Z handing construction,anal ha¢by autfarire repred Mm grnwnwives ir city enter uthetiCISMICahavcmcntimN papeny fm in"atian p.,— PERMITI.CSUANCEL'LECLR ]FEE O
(WO eg¢e to sass i:wemnify anal kevP b.,n 0r City of Curyniro.gainu
Instil itics,judgmcno,costs and capcnws which nay in any way acerae ago nst said Ch Y AL I'LR OR A DD TU MECII.
in csansryucnc IIn, ting 4IN'Permit. I'LU.M ,'C FFE
APPLICANT L ' ER5TANDS AND WILL COMMA WITH ALL NON-POINT AIR HANDLING UNI'1('10 11,(MMICI N I
A1F.CIIAN1t LIFE
SOUE RIiGU 1/ p
3 ^�7 AIR HANDLING UNIT OVER II.A)0CFhp CON STRU
ON TAI
ignwum nl Applic..bViolmnm Dat, EXHAUST HOOD(WIDUM) HOUSING MHUGAT10N FEE
HAZARDOUS MATERIALS DISCLOSURE
WII he afflionta fWum haihfingacapon sln¢abandit hauedausmmcrial BEATING UNIT CHI fxmmBTU)
as defind by dre Cupemno nwnici*Code.Chapter 9.13,ard the Hahn and Safety
Gdc.Serften 15532(a),' HEATING HEATING UNIT(OVER W.O((I 111 U)
t
El Y, rJrso
VENTILATION FAN(SINGLE RESID) PAID
Dam RcaiPt N
SSS11 N,tiftlicen or future building CCCuryn use eyuiperman or Mice,whicfi
emit amrdnas air cunaminunts us&-fi:rd by the Buy Arm Air Quallly Isaagenrn, BOILER-CUMPtJIIP OR fX1,pM1 MTU)
District? BOILER-COMP(OVER I W.001 B FU)
Elves
a
I have rAIR CONDITIONER
real me huzaadms nterial.«ymrenrw uMcr CttuPacr 1,95 of tete CWT- ISSUANCE DATE
Rroie Beaty WnY Code,Stttiw 8503.85JJ aha SSV.1 waakntend,hal if the N'IiW RIhSIUIiNTIAI.A113CH. SQ,FT. L n
hai Ninga4 s nrntlY huvcalvmnt,taut itisntyircof a enifto rodfy dte oavpwt -3 T 7 9
of prier m 6xarce of v Crnif�^f
lwnm moa'rcd vgcnr Dale TOrnL. ISSUIiU BY:
I OFFICE