25109 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
�� � OC
CITY OF CUP PERMIT NO.
NO APPLICATIONIPERMIT rLunlBluc.MecxanfcaL
BUILDING DIVISION =wyg�,nP;:,(Em�;tlUl[,DING PROJECT IDENTIFICATION 7'V:^v - c,
BUILDING ADDRESS: SANITARY NO. APPLICATIOON'SUBMIITALDAI
2 / UNIT# LOT#
1WNERS NAME: PHONE: C NTRACIOR'S NAME LIC NO:
Q _ X - g • NC CONTROL
RCHITP:CGFNGINEER: LI NO: ADDRESS: 1..V V ❑
ONTACT: PHONE: ``v C vtY'e:"/+sr,uasa^g- - `y t•F
/73] yrr,�oi E ECMICeewmT y ; +�S efmuuu reaavn¢aFd �, K
+✓5 e� Q- a Te J BLDG ELECT PLUMB MECH
PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL t�
C=Z I hereby affirm dam l am licensed under previsions of Chapter 9(commencing with j JOB DESCRIPTION
SCCP. Section 7(aimmf Division 3.f the Business and Professions Code.and no,license is in PANEIk
TUU full force and effect.
<ZD LiceLicenseClms Lic.0
y<y Date ContrSD I
7C)yZ ARCHITECTS DECLARATION I AMPS SQ.FT.F1000.AREA 5/SQ.FT.
Cxyp lundemmnd my plans shill be uxdmPublic records. 5�7.� ,��
W %EcnuCA t/Yn
<.,7,,1 LicenaM Profmimal SIGNS
z < OWNER-BUILDER DECLARATION SPE C
XO a F I hereby affirm mat I on exempt from the Contractor's Licenx Law for t
DI'�+p-vs following teaxa.(See ou 70313,Business asW Rofexiom Code:My city oOR PoLE
�'�'pyg which requim a pemtit m wnstroet ilter,impave.drnmliN,w Y=
��>� punto its iuuance.elx«quim the applicantfineuch pemdlm fileaelgned skkrmnI POWER DEVI
Kipz that he is licensed pmuentmthe proviilwu of me Contractm'a Licenselaw(Chapter S POOL ELECTRIC
x I 9(commcnring wiN Sectim]OW)of Divuion3 ofNe Buelau W Pmfmelons Code) VALUATION
W❑y w mat he is exempt themfsom and the breis far me ellegN exemptioa MYvichmon of OIlILCIS WITCIUS-PIXIlIRFS ` assas—
C2Q nalion]OJL3 by any applicantfwe Permit the applicant toaciviI penalty
ream men five hwtCmd dollars(f500). O
Y P Yemwimwagnmthe'vmlecwnpwtim, NEW RESIDEN'DAL ELECIR _SQ.PT.
tsmts��� ,mownerofdx propmy.arm em to STORIESTYPE CONST& Ot
y3t Ildotheamon."ld the etrmtum isnw intendcdorof(ertdfmsele(Sec.70aa,Buainm+
and arty wh builds;
at Cade:The Cnmracmla Limine Law doe ml apply m an owner as
Progenywhobuildsor viimprovermeaan,v who daoouchwMmoff wfm Wmhu
pro em.previdd thatamhim OCC GROUP RFS.UNITS
hawevey povcmenuart ass iearrdMaoxeM(w Wa U,
tthe building orimprovemmtisland withinmassycatocomoletlm,the owner,
sudo).r will have the burden of paving Out he did ran build wimpreve for purywe of _
lila.). ,vl r�Y?Yigeu•SIW-Al1YNasa1f 4
❑ I,mowneroftheproprty,amexeluaivelY contr¢ting wimlianxdcmtrxmnm w ,p- � yU-,Pya� � '�- FLOODZO APN
,commet the projecs(Sec.7(31,1,Business aM Protection;Cade:)the Contractors PERMIT ISSUANCE
Licenx law does rot Wl y man owner of pory pewho builds crimproves thereon,and
who cem acts instructs projects with.ematmnw(s)Bcenced pursuant In the Contractors aara�a�
License Low. '' �`�law. ALTER-DRAIN&VENT-WATER(EA) F1a� Y xl`
❑ 1 am exempt under Sec. ,B&P C fa mil rtaxn BACK FLOW PROTECT.DEVICED
SANITARY YN
Owner WORKMAN COMPENSATION DECLARATION GRAMS-FLOOR,ROOF,AREA,GOND. CHOOL TAX YECE�1'♦ N_
I ❑ Thereby e(ftrm marl heveamdficem of rtntmrelf-irtsum,watatifiweof RECEIPT#
A7
-PER TRA
Warkm'CwnpyCe S halruursnmmacenJed mpY therm!(Sec.3800,1ab CJ whiN P FEE Y N
coven ill employw's utWer mu Permit. RECEIPT X
Paltry# OAS-EA.S -1 C BUILDING DRHSIO
❑ CCora�uyiifidce GAS-FAS CHECK FFR
PY is hmbY funrishN.
❑ Cmified wpy is fi1N wire dk dry inspection divuim. GREASEANDUSTRL WASTE R G DING FEE - -
CERTIFICATE OF EXEMP7ON FROM WORKERS' GREAS TRAP FEE
COMPENSATION INSURANCE
(This xcdon necdnat becwnPleted i(mepmdl la(moa hmdrddollan(f 100) SEWER-SANITARY-STORM EA.2Wn. ENERGY
or lemJ
I mdfy that in the perfonmme of the wort,fee which this permit is issued,Ishat WATER HEATER WryFM/ELECM
net employ, any person in any mammr an as an become subject to the Workm' PAID
Z Campnsatianuvot.f California Date WATER SYSTEMRRPATINO
Acam ate RaeipX
ZPpli2 NOTICE TO APPLICANT.If,after making this Cvuficate of Excmmon,yen should NEW RESIDENTTAL PLMB. SQ.FT. TOTAL_
4 thecoma subject to the Workers Compensation provisions of the Labor Code,you most
forthwith comply wire such permit shell be deemed revoked. BUILDING FEE
pY provisions or this
d [] CONSTRUCTION LENDING AGENCY SEISMICFEE
I hereby affLm mat mem is a consmiclion lending agency for performance of
U p the wart for which thin pencut u issued(Sec 3097,Civ.C) TOTAL ELECTRIC 2 Q
V Leaders Name rat ,-r 'na - •. •ryy wv'
O Leaders Address - R a'NI W 4�e (• [IEE• l PLUMBBi
dlFEEI
I certify mel I have read this epPlieuion and.tete mat the above iNmmation is
tC. come.I agree mcomply with"city andcounrymdinancmandsw lawsmlatingm PERMIT ISSUANCE MECFLWI FEE
F' C. buildingcomtruction.andherebyinthwisenTru entivmafthiaciry m entrap.the CONMU ONTAX
U Z above-mentioned property for inspection purpam. ALTER OR ADD TO MECH.
(We)agree to save.indemnify and kecp homeless the Ciry o CLpnino.geimt
liabilitiw.judgments.cmuandexpnxswhichmayinanywayta`�ea sablCry AIR HANDLING UNT(TO III=CFM)
in comeque ce of the grSuing of this permit.
AIR HANDLING UNIT(OVER ID.M CFM)
gM ofA plicae ter Con Date EXHAUSTHOOD(WIDUC) PAID
HAZARDOUSMCTERIAIS DISCLOSURE HEATING UNIT(TO 1011,000 BTU) Dok Receipt
Will meapplicanmr future building oceupmt ewe or handle hunadom malmad HEATING UNIT(OVER 100.000 BTU)
ns defined by the Cupninu Mumd,ml Cads,ChaPkr 9.12,and the Health anal S.kty
Code.Seniors 25332(a)7
El Yea 13 No VENTILATION FAN(SINGLE RESID)
ISSUANCE DATE -
Will the uPP licuntorfmurtbuildin mxe triPmrn twdeviceawhi<hemit BOILER-COMP(JHPOR IW.WO BTU)
l by th. 9
hmm
alloair conmmunu m defined by theindefiBay Arca An Qaellry Memgemem BOILER-COMP(OVER 100,000 BTU)
DisWct7
❑Yes ❑No NEW RESIDENTIAL MECH.—SQ.FT. w
/�
1 have read the hmsrdaumaterials rials ree.irem mcunder Chapter 6.95 of dm PAI D
California Health&Safety Cade.Sections 25505.25533 and 2553#.1 undmkM than
,fupanbuilding drn:snmoicros lhich mmnantmet it myrtuance of isymnmifyme MAY
1
Occaput nl'me requimm me which must 1e ren prior m issuance bila Certificatehe 'I,/j( FI
cupancy.
uwrer praminrtiscdnOcm Dok TOTAL: 15SUFD BY� I
a