99090023 . ILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY q"m bOa
_,tJPERTINO BUILDING-ELECTRICAL PERMIT
.,DING DIVISION APPLICATION/PERMIT PING PROJECT
CT IDENNICAI, S0001
BUILDING PROJECT IUENTIh'ICATION
BUILDING ADDRESS: /D6^ / `— / � q-u ��/�� � SANITARY NO. APPLICATION Sillill"AI.DA'Z'E
OWNE "NAME: l/�CkP "PTHONNE/N( COX] ORS NyMEy LI NO:
(2^ /I L.S�/, �L/ L� �I NACfill CONTROL,
�III'I'IiOt/I!NGINIiI]R: LIC NOTi ADIPL C Wf��L D� VVVIIIKKK ��I"`���1/�WW�✓ ❑
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CONTACT PHONE: BUILDING PERMIT INFO
f Uz fit X31 A,y-s-/33 ❑ Consultant Fees Paid by Applicant(Initial) BLDG FLELT PLUMB MECH
❑ ❑ tai ❑
LICENSED CONTRACTOR'S DECLARATION QTY,' ELECTRIC PERMIT FEE
I hereby tdfina that I um licenv¢d under provisions of Chapter 9(commencing JOB,DESCRIPTION
W O p
0o'Z with Section Visual Dmkirn Joflhc Business and Profession RRMIT ISSUANCE Code,undnsyllcemc Ls RESIDENTIAL;
_ i > 1'
FW^ mPoll form and clic /G// ❑SPDWL -� ❑KITCIINN REMODEL
�UZul
U Do".License Clns Lic.H APPLIANCES-RESIDENTIAL CADDITION ElPLUMBING 12EPIPB
m d Contmetor
GARCHII'I!CTS DECLARA ❑MULTI-UNIT [ISTRUCTIIRAI,
E.pm PANELS p ti Z` 1 undersmA my
nplans smuseums usns public records MODIFICATION
oZ-�0 UP T02W AMPS El INTERIOR [I CHIMNEY ItIiPAIN
Nom.-,ply Licensed Processional 201-1007AMPS IMPROVEMENT CSWIMMING POOLS
OWNER-BUILDER DECLARATION OVER I(gNIAMPS C RATE REMODEUREPAIN DCMOIJ'1'ION
a 6 1 hereby anion a al 1 lm exempt from the Contractors License Law for the -
rad LL J following reason,(Section 7031.5.Business aryl Professions Coaw Any city or county SIGNS ELECTRICAL C OTHER
which rtyuircs a pennil to consmch eller,Improve,demolish.or repair any sttearc
p.,w4.OQ p�onoiuis... ,uLso or mbalhe applicant for such Permit file a signed statement SPECIAL CIRCUITIMISC.
SWC thalhe is licensed promint tolhe provisionswole,Comments license Law(Chaper9
W�CCC (commencing with Section]00(b.dDivision3 ofthe Business and Professional Cade)or TEMP.METER OR POLE Isla. IF
;s.3:x n¢ Nm he is exempt therefrom end the basis fm the alleged exemption.Any violation of ❑NEW BLDGIADDUFION ❑DEMOLITION
Section 7031.5 by any applicant for a permit subjects the arplicinr to a civil penalty of POWER DEVICES CIT17NAW ❑FOOD SERVICE
t more than rive hundred dollars IS5d(B.
=^} IMPROVEMENT
�=Qn pr',mt. o the worofthe pestructur myemntendeswithwageaastheirmletttmpemorinn, SWIMMING POOL ELF ❑OTHER
will An the work,mal thestructure is not imendW ornffered Tarsale(Sec.]I1W,Ilusincss
wit 3^ and Professions Code -[he Contractor's License Law does not apply to an her of OUTLETS SWI'rC1fES-FI R
properly who builds or improves Thereon,and who dons such work himself m through
his own employees,provided nonsuch improvements are not intended or offered far NEW RESIDENTIAL HLP.CfR .Q
sole,If,however,the buildogor hpiocemem is sold withinone year ofcomple(ir into SQ.FT.FLOOR AREA S/SQ.FI'.
pune,-milder will Imve the burden m preying that he did amt build or improve for Pur-
scntxnle.), .
❑L las owner of the properly,ant exclusively connecting with licensed anomalous to IOIAL:
Onsmuet the projeci(Sec,7IH4.Business and Professions CWe:)The Comnmlor'a U.
ease Law does not apply to an owner of properly who builds or improves thereon,Ona QTY. ' I'LUMBINGTERMIT FEE
who cunloods for such pmjema w Rh u e toratmis)licensed pursuant to the Conlmnm's -
Liccn.c law. PERMIT ISSUANCE
Ll I vat exempt under,Sm. .B&P C for This reason
ALTER-DRAIN&VENT-WATER(Tito VALUATION
Owner Dole
WORKERS COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
1 heathy afOnn under penelry of N,juty one of Ne fallowing acrimonious:
410IheVeam will mainmine Ccnidcate of Consenuo selGinsurc for Wmkees Co.,.. DRAINS-FLOOR.ROOF.AREA,COND. STORIES i TYPE CONSTRUCTION
crafter,as provided far by Section 37M of the Isb¢r Code,far the performance a Ibe
k which this permIX
it is issued. FTURES-PER TRAP
®'1 hmvc and will ntaimain Workers Compensation lonment as required by Section
3700ohbcltble Cal,for he perfommncer IJePwo1ir°kY{fuyr"'w�Qhji�ch Nis pemlit is issued. GAS-E&SYSTENUHNCAOUTLFTS - OCQ GROUP -7 G�red'N
Carriee�-'L I yNo.
w`* GAS-1iA.SYSTEM OVER 4(L'A) , O U
CHRTIFICAIE OF EXEMPTION FROM WORKERS' GREASUINUUSTRI.WASTE INTERCEPTOR COMPENSATION INSURANCE BUILDING DIVISION It
i r' _
(P his section torturer he completd fOhe pennBls finene hundred dollars(S1011) ORFASETRAP
or less.) PLANCHECK FEF. -
Icartlylhmintheperfnrmunceofthewarkfarwhichthispeneitolxsned,l shell SEWER-SANITARY-STORM EA.203 IT.
hot ample,any person in any manner an as lr bee m uchjem m the Worker,'Cn rem I COENERGY FEE
O z xmion Lows of California.Data. WATFR 1]EATER WNENT/ELEC,R Q, CO ORATING FRE
O Applicant
NOTICE TO APPLICANT:If,afar making this Certificate of Esemption,you should WATER SYSTEMITREATING
h became subject or he Workers Compensation provisions of the Labor Code.you must SOli's FEE
WF.t forlhwith comply with such provisions or this Permit shall he deemed revoked. WR'I'ER SERVICE ( �.
� a ;n
Z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.Ft. PAN ..kr Rmet p
L)O (hereby alBtt the,there is a concoction lendingagency Ponhe performance of
-I the work for which this rental is issued(Save.3197,Civ.CJ
TOTAL:
Lenders Nonce S C, TOTAL:
L) Lender's Address
1 crafty that I have land this application and sea that the above aid..ten is BUILD FEE
ycorrect.)agree to comply with all city and county ordinances and state laws relating to QTY. MECHANICAL PERMIT FEB
5.) z building construction,and hereby authorize representatives nfNis city to emcruptm the SEISSVc; 1E
mMvemcntionea property for inspection purposes.
PERMIT ISSUANCE
(We)ligan to nava,indemnify and keep M1annles l the City of Cupcnim¢,vias Ii1.F,CDe1C FE
liabilities,judgments,costs and expenses which may in any way accrue against said City ALTER OR ADD TO MECH.
in conM
rantingofthisrennin. PLUMBING FEF.AP , 'US AND WILL COMPLY WITH ALh NON-POINT AIR IIANDLING UNIT(ToI 10,000 CFM) MECHANICAL FEE
r''/5AIR IIANDLING UNIT(OVER III,IXXI CPM) CONSTRUCTION TAX
SignorCnmMetal - enc ' EXHAUST HOOD FVMUCT HOUSING MITIGATION FEF,
IIAZ.AIt000SM ERIALS DISCLOSURE
7 "Will th¢npPlivan lav fnttimhnilJt gmcupem store arhandlehnzvnlonemnttrial' HEATING UNIT(TO 100.0N)BIU)
us AclineJ by the CuPeninn Municipal Code,Chaplet 9.12,and the Health land Safety -
Code,Section 25532(x)'1 �ry�• HEADING UNIT(OVER 100,000 BTU)
Ely" -L/ VEN'I'IAT10N FAN(SINGLE RESID) PAID "-
Date Receipt N
n
Will the applicant a intra building Occupant use egvi it Qu or devices wheat BOILER-COMP QHP OR 100,(100 BTU)
il hamrJnus air constrainby the Bay Area Air Quality Management TOTAL:11 t
Dismlm] Yes BOILER-COMP(OVER 100,000 BTU)
I have mail the humrdnus m:�coals AIR CONDITIONER
requirements uMer Chapin ti95 of be Cali- ISSUANCE DATE
bantam Health 8 ry da,Smuo s 23505,8511 aM 8SJ4.1 underswnJ that franc NEW RESIDENTIAL MECH. SQ.FC
building Jos ecu a 'h: male ant.drat it is my responsibilirymnmify the occupant
ofthamplirt nts d m nth et pnnr wrotertmofa Cenif t oft , �_ C7
Osoar or nut t ed gem - TOTAL: ISSUED BY: �^ /
OFFICE