S 1423 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OH'CUPI3RTIN0 R=i-PIXICrRICAL PH rf NO
BUILDING DIVISION APPLICATION/PERMIT rINGPROIRCIRCBANRLM. 1423
BUILDING 1`Nlgl?CI'IDI!N'1'IFICAI'lI1N
0'ILDING ADDRISS: SANI'TANY NO, ill'1'I-KATION SUBMITTAL DA'TI?
C/1 9-5-01 ?rG
!Ip 'ries NAM[: E: CONTRACTOR'S NAME; LIC NO:
X97-6h- -L- N!C CONTNOL X
Ln
1111'1: '/ENGINEER. LIC NO: ADDRESS' ❑
CONI'ACI': PIIUNE:
RU ILDING PERMIT INPD
r•
9�6 w��l ❑ Consultant Fees Paid byApplicant(initial) ELECT PLUMB MICA
'LICENS CON'IRACfOR'SDECLARA'IION QTY F.I,ECfRIC PHRMIT FEE
I herehywE.m dun amEevised under prndoenes of C'Impmr 9(armmct"ll, JOE DESCRIPTION
MoZ wihSection 7000)ill Division 3oflhc Bruin—andPml'us.lon.Cudo......Illy license, PI,RMI'TISSUANCJ'. RESIDENTIAL'
fad0 in tall have I l ct'I'ca. ) I. ❑KITC1113N kl?MQDE[.
C U� License Cluny Lie.N
et U APPLIANCES-RESIDENTIAL DDH ION ❑PLUMBING RF.-PIPE
F Z IL Dam Conlon u
v1Qa MULIbUNH ❑STRUCTURAL
ARCHI'11:C1"S DECLARATION
'Doe PANT?L.S MODIFICATION
Z O y Z I understand my plans shall be used as public rnoNs
OZ-O UPI'O NNIAMPS ❑INI'EkIQR ❑CIi1MNfiY I
F`!)F'W Licensed Peaefsimvl 201-1000AMPS LMPROVf:MENT C]SWIMMING POOLS
�, I Naive fl m,Ill.,,I a,. lCf e.E he Comae..e,License,I.uw file the OVI7R 1000AMPS ARATIO [I HAITI kfiMODliIlltlil'AIR ElDEMDLI'TIQN
ce a
X360 following mason.(Section 7031.5.Basin...and Professions GNC Any city or cnuntYSIGNS ELECTRICAI. OTHER
W n-y which requires a Permit m construct,alar.improve.demolish,or repair any um<mre -
0
Q pno,,I Is izuance.also reyuims the applicant for such permit to file a signed smtematt SP17CIAL A1ECIRCUITIMISC.
f�T� hat he is licensed forward mhc provisions Contractor's License lrw(Chapter9
n�1�00 (OOmmencinS with Scainn]INM))of Division l..fhe Business crud Prolraions Csxlel or 'Uih1P. fER OR POLEI ."I' COMMERCIAL:
X e that he i.exempt therefrom and the basis for the alleged esempllon.Any violation of C1NF.W HLDG/ADD["I[ON ❑DE
d MOLITION
W�vr Section 7031.5 by any applicant fimnPermit subject,the applicant ur..civil penalty of POWER DEVICES El*1 ❑FIX>U SERVICE
.,it more than live hundred dollars($500). IMPROV I:MliMT
SSD I,ae owner ul the pntpeny.ar mY employees wih wages as their sole runup......lion.
SWIMMING POOL ELECTRIC '.v - f'
�F. will Jo duework,mllhw.lrurneisnmintendrdontRcad fur.... (See.Jlild,Ornnae 1 ❑OTHEk
a3 and Icofe.ssions Cod., Ill,Cnmucmr's License Law does ren apply In rut nwncr.d OUTLETS-SWH`CIIIIS-NXrukIS
pmpr:'t,wen builds o:n,hoo,herctur and who does such wild,hunwil or through
Ill,own cogloyccn,pun,alol Ilea such improvcnenn me not imm�dul nr attires for NHW It ESID17N'I'IAl,HLI!C'I It SU PI'.
n:Jc.ILnuwevcpthennildiftgnf lmpmvcnam is soldwithinone hmrnfannpinion,the n SQ I'I'.PL(E)ANIRA %/Sp.I'1'.
owner-bnlldcrwill have the h�rdennf preying that he Jid nm bails nr ifnpruvc lire Pury Q (�
pow nf.conc ,{.•J�I�D
❑ 1,us nwncr mf he See.7044.Business
exclusivelynd Protruding with licensed commcmn m
mwa the pruned(Sec.t)an Boniness and property
who Professions Com:)the Cnntomon, Li-
ecnxLaw dttexnmapply ots owner of hurnamnywcosedprometiwa hcmnmunJ QTY. PLUMBING PIiRMII' FEE (/w�`i/��x ��`•
who contracts lnnnch projects with vromr mr(s)IicenmJ putxuunu..the Comrvood
License Law, PERMIT ISSUANCH
0 I ant aempl under Sec. .R N I'C(arhis at
ALTER-DRAIN k VENT-WA'IT:R Ob") VALUAHGN
Owner U
WORKER'S COMPENSATION DECLARATION BACK MOW PR .UIIVICI?
hereby al arntunder penalty ieperjuryoneofthefollowing Jcclumtinis
t)i
-.ohme and will main mi neC37a of Co Laken ode.sure fur Worker's Compel. DRAINS-IrL I ARBA.COND' S' 1 P.$ 'TYPE CONSTRUCTION
anti....,use provided for n Section, 113](Xl of the labor Code,for the perlirrmunec of the
seers lire which This Ircnnit is in.vaA. FI%TURES-PER TRAP
O 1 have mW will thrown Worker's Compensation Insurance,as ueyulr, by Sermon
371Ntofthe l.nMu Code far the perfonerace ofthe work for which this proof is issued GAS-EA.SYS'1'HM-I IN OUT. S 16 G AI'N
My WnrAcr's Cnntpcmadnn Insunmcc wrier nnJ Pnhuy nnlnher um:
Crrier: Policy sh, GAS-EA SYSTEM-OVE3R q(CN
C; rl
CHRIINCIM 11 OF HXEMPI'ION FROM WORRIES - GREASI%INDDS'I'RI,WAS'IPIN'I'ERCIiPffia rVf
COMI'ENSADONINSURANCI? BI 1DIVISION hills
TThis"lion uredo hocnmdlfth pletc .I.it ix Greene hun Jrnldollurs($100) GREASE TRAP
1'LANCIIIiC"
TI-
.it less.) 6
.01111"t,
I certify that in the itcninmance ofthe work for which this permit is issued,l shall SEWER-SANITARY-S'IORM PA.200ler.
not entployany per,r anrm nne,,in stn hecomewhject nt the Workers'CnmMm ENIiRCYP AO
Z union Laws of Carlonfin.D:mc J WATER HEATER W/VENT/FLPCi'N
z Q Applicvnl GRADING IIJi
NOTICE'TO APPLICAN'p:If,slier making his Cenificam of Emmpuon.You sh..uld WATUR SYSTHMOTHATING
a? SUMS FIiIi
hectare bjerun the Workers ComperNvmon provisinns..f he Labor Code.you most
su
W forthwith comply Is fill such p..visions or this Perot shall It,decreed focused. WATER SERVICE
=z CONS'1'RUCrION LENDING AGENCY NEW R[SIDF.NTIAL I'LM11H. SQ,17. PAID Date Receipt X
UC) I herebyadimn that is a connmcorm lendingagency,fonhe performance of
F he work I..which his ,.if I,issued(See.3097.Civ.C.)
Q Lcnik,,Nana TQfAL:
rWU Lender's Address
1��.f 0. 1 certify thin 1 have read this application and state that the above inlluno&m o BUILDING I121i
L, 0 correct l agree to crnttply with an city and county mdhwnms andsunc laws mlminS to QTY. MECHANICAL PERM IT FEE SEISMIC FCH
Uzi bn'dtannanumiun,;Ill fondly auto mpewateiva'of hi,,tyto cmcrnpon he
uhnvcnmmiuncd pn,;AYfy for Imlac,ohn Purgrses. PERMIT ISSUANCH
(We)sgveu It save,inJcmndy and keep hurnducs he City of C'tgertino against I11.HCI'k IC IlCli
Whitli x.Ianhatenls,comand uasnov,wo,hmny luny way aecrumtgahr"uid CityALTEN OR ADDTOMP 11 PLUMBING II?I?
it,con's, ill'he granting of tills pomil.
SAPPLICAN
OURCHM.'UNUI.IONS. SAND WILL COMPLY WITH AL1,NON-PAINT AIR HANDLING UNIT TTO I(I,fNxICFMI MECIIANICAI,IRI? 2 (�
BOUNCE REGULATIONS.
AIR HANDLING UNIT(OVER 1(L(MNI CITU CONSI'RUCI'ION'LAX
Signature of Applicvnt/Commetor [)aro EXHAUST HOOD(W/DUCT) HOUSING MITIGATION PHH.
HAZARDOUS MATERIAI S DISCLOSURE
Will the applicant or future building occupant mom or handle h:vaNnus mvional I117ATI NG UNIT ITO 100.000 BE UI
as defined by he Call no Municipal Code.Chapter 9.12,and he Ilealh and Safety fiATING UNIT(OVER 100,000 HIT)
Cute.Section 25532(a)? II
0Ym ❑NoVENTILATION PAN(SINGLH RISID) PAN Dam are#
Will he applicant..r Immrt ImilJing ucrupam me equipment or Jevicex which BOILER-COMP(BIT OR 100,0 0 RE U)
nil hvaNnus aircom..minnnn us defined by the Bay Area Air Quality Management T)i'
District; BOILER-COMP(OVEN 100,00013M)❑Yes Cl No
I have mad he Roardous m:tie ials o is an is Cho ler 6u95 of he Cali- AIR CONDE I'IONER ISSGANCF DATE
25533 a
torula llculfhR5ufcty Colo.Snaiom255n5,25533 and 255J4.1 understand lh:n it N17 RESIUIiNTIAh MI!CII. SQ.PI'.
ntrdtf ng nurse ren rufrrm r n:tau a mimm.Ihat a ix rnr rcxPnnsin0lty fo orf.b Ihr hs n,vP..m `
nnl:u mntamm:u:..n wlnrh Ittn,m x mel pdnro-t iwuancc m a cenhwm of Oce:y,::ney.
Owner nr uwhurienl agent Ualc L ISSUED BY'.
OFFICE