S 2766i
i
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPF.KPINO BUILDING - IMECTRICAL
BUILDING DIVISION APPLICATION/PERMIT PLDSIBING "%IEGIIANICAL
BUILDING PROJECT IDENTII'ICA'ITON
PERMIT NO.
S 2766
IIUILDINGAUU121155; -
SANITARY NO.
APPLIC'ION SUI II'IAL DATF.
2 IN1
3ZS�
OW .R'SN it,': PHONIF
Co
CO RACE :S NAME.:
LIC NO:
Int
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LI y0:
ADDRESS:
Tl Il
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PHONE:
TtENGINEER:
BUILDING PERMIT INFO
CnnSullanl Fees Paid by Applicant (Iniliap
EL�/ PLOB nmCII
BInG
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LICFNSFDCON'1'RACT R'S UFCL ATION
I benchy mfirin that I am ha a,en an .r prn.looms ,I Ch.lnat 9 (ca. unsealing
QTY ELECTRIC PERMIT I'E17
JOE DESCRIPTION
PERMIT ISSUANCERESIDENTIAL:
with Smtinn 7lXXB of Division9nf the Business vnA Prufcssions Cole. and mylicenxc is
in full fnrcewW effect,
❑SPDWI. ❑ KITCHEN REMODEL
APPLIANCES - RESID-NI'IAI,
License Clan Lick
Dote
❑ADDITION ❑ PLUMBING RGPIPE
C1 MULTI -UNIT STRUCTURAL
MODIFICATION
❑INTERIOR ❑CHIMNEY REPAIR
IMPROVEMHNT C] SWIMMING POOLS
TSConDELL
CTS DECLARATION records
nJ tib an I cos �d as pnhllc rnmdx
-
PANELS
uPT)21M)AMPS
Licm J al sl)
201-I(XXIAMRS
OWNERELDER DECLARATION
1 hereby affirm that 1 of xempt from the Contractors License Law for the
following rcevon. (Section 7031.5, Business and Plufessions Code: Any city or county
❑ BATH RGMODEUREPAIR ❑DEMOLITION
OTHER
OVERINXIAMPS
SIGNS ELEM RICAL
which nNohes a permit m amxmmt. alter, improve, demolish, or renal, iny mmeture
SPECIAL CIRCUIT/MISC.
priorm its isenance. also requires the applicant for such permit o fill u signcd,tammm.t
that ha is Iluensul pursuant in, the pmvixions of the Contractor's License Law Cantrell)
(commencing with Section 7lNNgof DlviomO ofthe Businessand Professimts Code) it
TEMP. MEI HR OR POLE INST
COMMERCIAL:
that he is exempt therefrom and the basis for the alleged exemption, Any violation of
i] NEW BLDG/ADDITION ❑ DEMOLITION
Section 71111.5 by my applicant for a permit subjects the applicant to a civil Penalty of
POWER DEVICES all
ENANT [I FOOD SERVICE
not more wn. Iivc hundredAollaO (&cra,l
]1,.snwnernl theprztpeny,nnnycnapinyeexwith wages vsthcirxtdeenanpensntinn,
will do the work, and the surae W re is mot intended andarod lot sale (Sea 7044. [1 isinem
and Pride, into Code: The Connector's License Law does not apply at an owner til'
property wall) builds or rationales thereon, and who lines such work himself or through
his own nnployces, provided that such improve.eno .re not intended or offered far
vid,If, howcvetthe buildingor intpmvemem issnW within oneyearofeompleion,the
IMPROVIiMP.NT
❑ OTHER
�SWIMMINGI .,ECI'IiIC
d DUTLEIS-SC i>I X'I ORES
NEW RFS 11)1 AL F: 1J: ' alSQ Il'.
SQ. PT. FLOOR AREA USQ. IT.
-hander will have the harden of proving dart he aid not hued nit improve for pm'
por
I, as owner of the property, um cxduslvely contmming with licensed ambanoax m
1.arxowne
G CaY{
01 t
o..Ban the pngea (Sc, 714, Business and Ptofexsions Code:) The Comramoi s Li -
close Law does not apply to an owner ofpmpery who builds or improves director anti
QTY. PLUMBING PEIi FEF,
who contracts for such projects with a con recux(s) licensed pursuant to the Contractors
PERMITISSUANCE,.
License Law.
Ism exempt i der Sec. , B CTC ka,llis reason
NAA
ALTER - DRAIN de VENT- WATER EA)
Owner Dole
WORKERS C(lS1PPNSATIONIllII ������111111
I hereby affirm under pnnhyof per a t ofof� g leclam s:
❑ I huveand will mvinminaCertiticamot uo self=6r6a Worker s.No.
sation, as provided for M1y Suction )71X1 cf t k:u ur Co or th F.n.nume of the
orkforwhich0aisperoailo"oacd ,I�fl }[ fIA� II .v�e�...�eW�(np'I
HACK FLOW PROTECT. 1lIiVICC
DRAINS- FLOOR, ROOF, AREA. COND.
STORIES
.r
/TI—
TYPE CONSTRUCTION
VIX'1'111tES-I'HRTRAP
3700ofWarkersaboaCnsation lncurancecae" Ibl tYs t�mvqrAmiel7emd�WVMed
aafItt pg91y{
Cartier if cy No
GAS -EA. SYSTEM -I INCA OIJ' ., S
OCC. GROUP
�{ MIN o
"'�� �Z
GAS-EA.SYSTEM-OVER EA)
CERTIFICATE OF EXEMPT FROM WORKERS'
COMPHNSAHON N$IIRANCF
(Tb ....lion need not he cuanplcteJ aft ' AJ
nrle+x.)
CREASE/INDUSTRC AS I'Ii INTERCEPTOR
BUILDING DIVISION FESS
GREA51i'I'RAI'
r
SEWEiR-' N)I'ARY- STORM EA. 200 FT.
heperfneurn,ofai nbecon which this permit:, issoed,Isoll
ier-
tat employ any person in ens manner xu ai m heannc subject m the Wnrkeri Comprn-
Toy anyflad Nissan
IiNFRGY PER
WAT' HEATER WNENTIFUiC111
,alio. lawsof California. Dam
Applicant
GRADING PGE
NOTICE 10 APPLICANT. 11; Wier making this Cenificme of Eisen F.lmn, you should
Ivenmea iect ha the Workers Compensation provisions of the Lalmr Code, your
'E'ER SYS'I'EM/I'REATING
SOILS PEI?
-
WATER SERVICE
forthwithcomply withsuchprovisions orthis lefri )all[ ba deemed trellised.
CONSTRUCTION LENDING AGENCY
1 horehy affirm that is a construction lending agency fit the performnce of
NEW RESIDENTIAL PLMIL SQ, 14.
PAID
Receipt p
rite work for which this prearit is issued (See. BIN)?, Civ, C.)
L erdcr's si
V 'I'OfAL:
Lenders Alone,,
1O1'A1.: -
BU1j_ I. aliF. 7
I certify that 1 have read this application still state that the above information is
mat lag. in comply wdh all city and countyordinances and state laws relmingm
building construction, and hereby amhonze representelves of this caym enter upon the
above-mentioned propeny for inspection purposes.
(We) ngrce o cave, inJmmni fy and keep haradexs the City of Culvert ine against
QTY. MECHANICAL PERMIT FEE
An
SETS ITE
lay
PERMIT ISSUANCE(s
FLECT IC ITE
ALTER OR ADDTO MUCH,
PLU ING IEEE
livbiliaay.judgnentx, corps mW expenses wlad oecy initis way accnm ngninst said City
incnnsequence.f Negmntamer toolona
AIR HANDLING UNIT (DO I0.001CFMi
MF.CHA• CAL PF.F.
An LIC, IND SI' ) AND WILL COMPLY WITH ax I. Nfj N -POINT'
SOU i( UI ON,
ATR HANDLING UNIT (OVER 10,IXdif
CONSTRUCTION TAX
A
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�/1TXX
SignalL l oplicam/Contrmm Dao
HAZ Rl ISMArTRIN,SDIRCLOSU B
F,XHA(J S' 1'1 IOOD t W/II UCI}
IIOl1SING MI'I'IGA'1'ION FL'I:
HEA'T'ING U N I r TO I OUdXXI B' I' O)
a 11 the applicant or future building occupant store or handle hay.anloux material
at defined by the CLpenino Municipal Code, Chapter 9,12, and the Health and Safety
Cole, Section 25512(a)?
HEATING UNIT (OVER 100,0N) BTU)
rrr---fff
VEN'I'ILA '1'[ON PAN fill NO 1.17 RES I D)
Yes -pill
Will, the npplainf or hatebuilding matipanl use a uipured ordevic R which
emit hazardous air emanational as defined by the ling Area Air Quality Management
Distill?/
❑Yes
PAID Dut�� /}
BBB
BOILpR-COMP(3HPOR 111,(X10 NTD)
f A
BOILER- COMP (OVER 1D1,000 BTU)
AIR CONDI'fIONF.R
(y(y
I have ren ""'y Clardnux m:ne�iuls reynircmenfv ander Chapter (JS of the Cnli
1'nmin IToalt a R Safety Cox Su tion 25505, 25531 anal 25594, I mulcrxtnnA that il'Oe
builJin• me l)0 a.t,thmif isms ranal liibil'ny n until tbonceupum
a am
�( J
NEW itl?SIIIIeNTIAL MUCfI. SQ. I'I'.
xl�ae n pnann i smsec of a Csni a4l of cy.
.ems
ISSUEDBY: •��
TOT L:
ut WzeJ Dtc
OFFICE
A