S 1137 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPE RTINO RUHAHNG-ELECf'RICAL PERMIT NO.
BUILDING DIVISION APPUICATION/PERMI'PPIAsIBING-MECHANICAL S 1137
BUILDING PROJECT IDE.NrIF'ICATION
UILDINGADDRRES//S,, �,�f/I,� SANITARY NO. APPLICATIONSUBAII'ITAI.DAr-
gJcV 2AN4
OW eRS N�.t I?' I'IIONG CDN" ACTOR'S NA LIC NO'.
K CO K$ GL L NICc° D°I""
11
ARCHrfECUENGINE:ER: LIC NO: &DURESS: CL�/UA A v0' ❑
CONTACT': PHONE /� BUILDING PERMIT INFO
C-- O itis N- 6�V ��/—/ L
El Consultant Fe,x Paid by Applicant(initial) BO eLecr x111 ntE
Co D
CT
LICENSED CONTRAf0R'S DECLARAION b QTY ELECTRIC PERMIT FEE
I hooby a1Rrm mat I am Ikenwd oder ImwiQons ofemagcr 9lcomtneltcin, - /17 JOB DFSCRIPTION
oaIZ with Secxon'/IlpnofUivislon 3 ofthe Busini.ttd P.rfeada�caea.arw myliceme ES
is RESIDENTIAL
W O p PERMIT ISSUANCE
��— in full force ort.Rats ❑SEEWL ❑KITCHEN REMODE1,
,U� Llc.Class Lich APPLIANCES-RI5IUFNTIn1, ❑ADDITION [I PLUMBING HE-PIPE
at forte cmurct«
FOy ARCHITECTS DECLARATION PANELS ❑MUhTI-0NIT ❑MODCTDRA
Z O�Z Iandfit my Plan.dull be u.,d ns'hlk ramp MODIFICATION
OZ—� UPT0300AMP5 0IN'11:HIOH ❑C1BMNI:Y REPAIR
W Licensed Pmfaoormd - 3014"AMPS IMPROVEAIFNT 0SWIMMING POOLS
OWNER-BUILDER DECLARATION OVER IIXUAhf YS ❑BATH RII.1QD1iIJREPAIR ❑DEMOLITION
I hereby BE.that 1 an essn x tram the Ciot.tor's Lxense law for the
K O�U followin cera.(tiafwn 11131.5,Buunn.ntW Professions Crdc An -t t ❑(YI'I II!R
LLl tg..� g r� y city or mon Y SIGNS IiLECI'RICAL
LL(n rot t(Lis iss requires.pend o,to ttxrY W R aIle!,imprUK,h ennif t rt repast Ny YNctYR
C t'. IS 14.4
�g priirtmiL.i.cwwrc.al.u�tcyuirnIhc ePPlicum Lv.wdi pcmtino fkaei6nwl aalcmcm SPECIAL CIHCUIT/MISC.
996} thst he ix licxnsedlMsuanl to the ptovisianx of tbeCmtracmis l.ianse law lCTapter9
SaQ lunu.co.mg with Schon 700O)uf Division 3 of 16e Busimss aril Ponfcvsion,Cods)or TEVIP-METER OR POLE I COMMERCIAL
d y a y that be,is exempt Nno foo..and the basis fm the all,eal exemryim Any violntitm of ❑NEW HLD i/ADDITION l: 101 ITL ,
lull , Sccoon703 L5 by tiny alrylwvm f«apermit subjablbe applicant m a civil p ty of POWER DEVICES �Tr�AYr ❑P(x)D SERVICE
«' m more than five hundred dollar,(5500).
F Z} OTHERINjPR0CMENT
_Q �Lo BIC wir.f the Propeny,or sootinvy<e.wimwroclhwcic(Sc .mmpcmvion. SWIMMING PTO URIC
will drahcw«k.Cloate,shoornoc Conaonxinlcnt$d nrolfmW Lr W."A,JBW.awne,o, OTHER
and Prof who b Code:The Cwwacral.License Lew tae,rat apply m an,arca of OVIlEfS-. ITCHES-FlKTUR
n B— pmDaty who badm«impnrvc lhcrain,nd was mxx such wt.t nimeP«mmagh
his nan employees, iosidsJ thv such in,rwvernenn are rat inuenalcd ar,Rend for NEW RP DFNTIAL FLEC R S ler
aide. Iuwcrcr.tM building nrimProvemcm iss ldwithinom yav nfcumplairm.the SQ.Fr.FLOOR AREA 5/$Q.14.
mer-huilder will lure the burden of proving Thal he did nn tvilJ rc impnnc f«ptlr-
,a,of sale.).
E] I,.,—r M he prc.lird,am esdasivoly......ctno,with Ii,r—d unoomnrn L. TOT&.:
..I tae p ojat(Sec.7I1fJ,Ran.and Pmfesxima Coded The C..&,Ll-
tense Law don.not applymunowmrofMnnoywhobuildsor inpmvoithem,aunt f.AY. PLUMBING PERMIT FEF. PAID
wlweantrxufm hpmjauwitha eontranm(.)licrn.ipu amlhe Cool oJ.
Liccnxc Ww, PERMIT ISSUANCE:
N AF order Sec. .B&PCfar thix.caum
ALTER-DRAIN&VENT-WATER(A) VAL ION
Date
)RKE O, I'II,'SATION DECLARATION BACK FLOW PROTECT DEVICE CITY OF Uumn i BvV
Waa
I bembya no&, salt ,, cqu'un,oflhe followingdciaannow.
n Iha,eardwillmainaina err 'a4 of Conscn to rlf-inwrtf«W«tcd Canpm- DRAINS-FLOOR.ROOF,AREA.COND, STORIES 'rYPECON. (RUCTION
cation,as pnrvidal for by Section 37W M the Hoare Codi,.fur the p:rlitmtnme of the
wort for which this permit is iusual. FlKTORES-PER TRAP
❑I M1ew and will mainmm W«kers Co npc union Inwrxxa m rryuintl by Ssctkm
3T of the labra Coale,for tlr penrfmnuee ofte work for which this Permit i.ostxJ. GAS-EA.SYSfF_V1-I INC.R OUTLETS OCC.GROUP APN
Aly Worm's Cnmpensstim Inwrame artier tint Policy number oa:
Came,. Policy Nu.: GAS-EA.SYSTEM OVER J(EA)
CERTIFICATE 01'EXEMPT]ON FROM WORKERS'
COMPENSAITON INSURANCE. GRIASPANDU.S RL WASTE.INTF.RCIH'IOR
BUILDING DIVISION fRi13
Ice,.)
(Thi,rection tied mr he compkifine te pmnit morass,hoMmlJdWn IS 100), GREASE RAP
« PLANCHECK 10J3
I cenify fast In Be perfi .aofthe work dor which thi.l'ernit k i.ed.I shall
ntemploy tiny pcnnn in any oummr w as to bemire abjmt to the WoAxrr'C«open- SILVER-SANITARY-SBIftM IiA.31q FI:' INERGYITE
OZ astim las, fCalifornia.Dam WATER I II'AI ER WNR.T/ELECrR GRADING FEE
z O Appli.f '
NOTICE:TO APPLICANT.IL alfa matingfhia CcniOcvc ofEmmryim,yna,hould WATER SYS'TIMI'READING
hewn a subject m the Wmkers C«npcnwtion poo.,nn,of tic_haat Code,y..0 row SOILS TEF.
Wfnnhwitb comply wuhuncib provi,iotoor this iemiil,hall M deemed rtvnkcd WAI'1iK SERVICE
Q Q
CONSTRUCTION LENDING AGENCY NEW RF_SIDIIIJI'IAL PIMB. SQ.PL PAID
U OI len,by affirm thin tole k n conraracfion lerxhng ege.ey f«tis perforrrwrec..f Receipt x
the wud finwhu,h this pcoon is issued!(S .3mll.Ci¢C) TOTAL
Nano
[U Lenler,AMrc,s TOTAL:
I.ratify that 1 have react Thi,appli flori mil state that IbeM
tive inf«malion i,' BUILDING IEE
fail cm t.lagtocomplywimellcitya,dcmnty«divrccserd.mtclaw,mWingto QTy,, MECHANICAL PERMIT FEF.
U buildin,conxtracT,and bncby a non,mprccnmtivcsofthia citym cnerogmtho usmic PELT
elwve-nrrnOorN propeny f«impcetian purposes. PERMITISSUANCE.
(We)agree m rave,indemnify ofd kap hannlu.Oe Cif,of Cupenioo egainu ELECTRIC FEE-
IieMlities,jWgmrnts.ants atd expen.which may in any way accttxagtiiw,avid Pay ALTER OR ADD TOMF,CH,
in mnseyucn«of lis grantin,cfthk,cronal. PLUNIHING FEE
APPWCANT U 'RSTANDS AND ILL COgiPLY WITH ALL N N-POINT NR IIAN DLING UNIT('IT)10.gi1 CFM)
SOURCE REG TIONS. C MECHANICAL FEE
AIR HANDLING UNIT(OVER 10,000CFM) CONSTRUCTION TAX
tLasall,'c.&A,36.n UG t« Dale EXIIAUSTHCIODIW/DUCD
DOUS MATER SIIISCLOSUAP. HOUSING MIIlGAT10NIH'E
Wllthcuppllcdnl fwurchaddo, upam,mrcornndlchwoudturnWaial HEATWG UNIT ITO 100.000 HTU)
as defnN by the Culxniru Municifsil Cods.Chapttt 9.13,end the fleahh end Safety
Cub,Section 29533(a0^. HPATWG UNIT(OVER 00dX rU) n
E3 yet F1 No VENTILATION FAN NINC,:RESID) PAID ' L.r
Will lbe aWlia « Fuidm egmpmm�r or�ice,which at
nf future ing tecup. use W iRacipt 4
BOILER-COMP Off RIW.q)O BTU)
emit haaaNw,est mn,amiwnu as JcOred by tis Busy Arta Air Quality Kfawgmen
nyrnl:
j
rin? BOILER-COhf OVER Ifq.(IfU NTU)
�Ycx ❑No
Ihavereadr ba v3u,rrmxn'ilw rryu'vcnemxuMm Llupte 095 of rise Cali- AIR COND ONER ISSUANCE DATE
m.Hdlth& y Code,Smit 25505.25533 and 2553:.I uMerttaW that If de NEW SIDE- AL NIECE. SQ,Fr.
Jing drx, of rtently Tuve. dutifi,mymnlaxmailirytunxify lis n«upant
c hmlut u ' cnfaCmir
oast toad m Ilalc TOTALa ISSUF,II BY:
OFFICE