99090177 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY ,0
CITY CUPVISION BUILDING-ELECTRICAL. iftlw
BUILDIDI NG DIVISION APPLICATION/PERMIT PLUb1BINC-NIEC'l1ANICAI.
BUILDING PROJECT IDEN'T'IFICATION
BUILDING ADDRESS: BUILDING
NO, APPLICA'IIUN SUBMI'ITN.DATE
OWNER'S NAME: PHONE: �VO LIC NO:
6:8vaAff Ito lygo 0M6 S Gfo 6('By3184�IKi6 N/c CONTROL#
'kCHITI!CIIIiNGINF,ER: LIC NO'. ADDRESS', ❑
,. Pk by IWOA Uo 6.Vq%A k. MQQIgVJgEl4'Awv0%9
CONTACT. PHONE. BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
�v�cG �(2s6oM I.So)961- *033a ❑ ❑ ❑
LlcensP:n cD .An OR
DI:CLARAFION QTY. ELECTRIC PERMIT FEE
I hermY affirmal mI am Beenwd underm
pv,ver,of chapter 9 Rumrn
mdng JOB DESCRIPTION
Z with Section 7NM)of Division 3ofthe Business end Professions Crwle,and my license is RESIDENTIAL:
in full force and effect. ' p /�p 6 PERMIT ISSUANCE ❑SCOWL ❑KITCHEN REMODEL
QUU License Class
Lin, E —1 _' APPLIANCES—RESIDENTIAL ❑ADDITION [I PLUMBING RE-PIPE
F Z m cmc Crmmaor L A AyF2y
❑MULTI-UNIT 0S'I RUCTURAL
OARCJiI I'ECT'S OF;C AItAFIt� PANELS
F N N Z 1 nd mY plane s tall tic records MODIFICATION
ii: UP 10 2110 AMPS [I INTERIOR ❑CHIMNEY REPAIR
hHt Licensed Lim ,"mal 201-1000AMPS IMPROVEMENT []SWIMMING POOLS
Y YOWNER-BUILDER DECLARATION - OVER I000 AMPS C1BATH REMODEUREPAIR ❑DEMOLITION
CL y�Q I hereby affirm Ihul 1 ant exempt from the Contractor'.¢License Law for the
p 3 L U 4dlow'mg mown.(Section 7131.5.Pfaainms and 11...cooCode:Any city or enmity SIGNS ELECTRICAL ❑OTHER
LL f4 y which requires a permit to construct.abet.improve,demolish,or repair any strucmrc
lJ prior to it,issuance.also requires the applicant for such Permit to file a signed statement SPACIAL CIRCUTOM ISG.
E'�Y'g thm he is licenwJ pursuannuthe previsions of me Cnmmdors Littnu law(Chaptcr9
COMMERCIAL,
>:�00 (commencing with Section 7")of Division 3 rfthe Business and Pmfes,irnClde
s )ur TEMP.METER OR POLE INST.
a L>C that he is exempt therefrom and the basis for the alleged exemption.Any violation of El NEW BWG/ADDITION ❑DEMOLITION
' may Section 70315 by an,applic:muban pvmil subjects the applicant it)x civil penalty of POWER DEVICES [I TENANT E3 1700D SERVICE
an,more than live hundred dollars($SW). MPROVEIVENT
=� O Las rwvnendthe p,a,ry.onny employee,with wages as their ode compcnsminn, SWIMMING POOL ELECTRIC
F. will do the work and lhestrveture is not intended or offered for sale(Sec.7W.Business OTHER
ama
3� and Professions Code:The Cotnofs License law does not apply to an owner of OUTLETS-SWITCHF'_S-FI%TUNFS
property who builds or improves Ihercon,and who does such work himself or through _
his own employees,provided that mm imPmvnnent,arc nm intended nr uttered for NEW RESIDENTIAL FLECTR SQ FT _ _
sole If,however,me building orimprovarmnt is sold within one ycandmmpletinn,the Q.FT PLf Luk AREA
ow r-builder will have the burden of proving that he did not build or improve for pur- X
poo,of sale.). `
O prop¢ y,am exc uslve y contracting wi TOTAL:
I.a,owner of me n I Iwith licensed mmmem,I m the project(Sec.7W,Business and Professions cube:) necorouior'sLSEA 2 3 w Law docs not apply m an owner rfpmpcny who builds or improves thereon,and QTY. PLUMBING iRMIT FEF. Irl's
1999 construct
who ens o.,tot such pr jec,with a cnntmnor(x)Iicarwd par manl[(,tire Conoactors 1
License Law. PERMI"r ISSUANCD 1 i
❑I am exempt under Su. .B&It C for this meson r,-
ALTER—DRAIN&VENT— RH: [ _ i-� VALUATION
Owner Date '•�---
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVI a
1 Enoch,off res under,senalty of perjuryanc of the following declandionu
I have and will maintain a Certificate of Consent to self-insure lite Worker s Corpon. DRAINS—FLOOR,ROOF,AR CON STORIES te 1'YPECONS'I'RUCHON
.,ition,as provided far by Section 37W of the labor Cale,for be pecanrmance of the
work for which Ibis permit is issued FIXTURES—PER TRAP
:r
I have and will maintain Workers Compensation Insurance,as required by Section
1100 of the Labor Code,for the Performance of the work for which this permit is issued. GAS—EA.SYSTEM-I INC.J OUTLETS OCC.GROUP /APN�•J
My Worker's Co nnensmion Insofar.carr e,and l'n1'my numhyf ore: C
Carrier:ig1n1 Inw!2.Na i'olicy Na:7gYyoO LTBQ7t� GAS-LA.SYtiI'IiM UVER4(EA7 C) 13-3
CERTIFICAI'EOF EXEMPTION FROM WORKERS' GRGSMNDUSIRL WASTE INTERCEPTOR
COMPENSATION INSURANCE BUILDING DIVISION PEES
(TTisseshis.ncedoot he completed if the pcnnit is faros¢hum)rtd dollars(SIW) GREASE TRAP
PLANCHECK PEE
m Ins)
Iny0 ythat hthe pen nabacto,oewmkfor whichthis Permit.Oo,C,lnbellver. SEK'ER-SANITAkY-STORM F.A.31X1FT.
nuI employ any Acmes in ony nwmer so ns e.becnine euM1jcct nt the Workers'Cnngmro ENERGY FTSE
Z scion Law,of California.Date _ WA IER HEATER WNENT/IiLECFR GRADING ItiE
z•� Applicant
z N NOTICE TO APPLICANT:IL after making this Cef ificam of Exemption,you should WATER SYSTEM?REATING
(- became subject to the Worker's Compensation provisions of the Iabar Code,you must - SOILS FEE
a > frrlhwim comply w lth such pri,skiooa or this permit.,hall be deemed revoked. WATER SERVICE
YJ La
PAID
5CONSTRUCTION LIiNDING AGENCY NEWRESIDENTIAL PLMB. SQ.PT
I herebyaffnto that isaconswction Itufiogagency for the performance of Date If p
Z
the weak for which this rKman is issued(Sec.3011.Cir.C.)
TOTAL:
U Undoes Name
TOTAL:
Lcndn's AJJre,,
I certify tlmt I have applicant rnai Otic applicaf nn I xoac hat Ihe mase Infoomminn i, BUILDING
In correct.I ngree lociandy with all city and countyoNinerves and sine laws mialarg m QTY. MECHANICAL PERMIT FEE SHISMIC FEE -
UZ building contraction.and hereby suthodm representatives of this city to enter upon the
above-mentioned property for inspection improves. PERMIT ISSUANCE ELECTRIC FEE
(We)agree m save.indemnify and keep ham me City of Catania.against
liabilities.judgments,costs and extwmws which may in any way accrue against said City ALI ER OR ADD*10 MECH. PLUMBING PEE
in ern vRenae of the griming nl'In,permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POI N AIR IIAN DLI NO UNIT('1O 10,01X)CFM) MECHANICALT i
SOURCE REGULATIONS.
a /99 AIR HANDLING UNIT(OVER MOORS CFM) CONSTRUCTION %
Si are of Appbc UCrmres / oUates EXHAUST HOOD(W/DUCT) HOUSING MITIGATE NFEE
HAZARDOUS MATERIALS DISCLOSURE
Will theapplicant or I'mine building occupant.foreor ban He hatanlmmnumnal HEATING UNIT(TO 1011,000 BTU)
as defined by he Cuperino Municipal Code,Chapter 9.12,and the Health and Safety
Cube,Section 25532(x)^ HEATING UNIT]'(OVER I W.000 OTU)
U Ye, KNr VENTILATION FAN(SINGLE RFSID) PAID
Date Rraeiptif
Will the applicant or future building occupant use inim mem or devices which BOR FR—COMP(3HP OR W,IXXI BTU) ))
,it hararlous a,eomm,tinuue us dc0ned by Thu Bay Arca Air Qmthly Mma"a mi 'IUT'AI' 1 to -J 5
istriaitss�� BOILER—COMP(OWRFpgHIBTU)
❑ 9Yes No
I have read the bvallou,materialsms,moments under Chapter 6.95 ofthe Cali. AIR CONDITIONER �`SS//lU���A...NCCE DATE (Q\
frmia Heulih&Safe
Gak.Selina'25505,25533 and 25534 1 umlcmanJ that if the NEW RESIDF.NTIAI.MECIi. SQ.�. /,..� Q
building docs nm cumnOy huvcafcnant thmdlanty rc,rynnihiliry lr notify the occupant
ofthe ennmxwhiehn Orrin, sc rfa CrmiGcumoflk upmcy.
omhariz 6nnl Da TOTAL: ISSUED BY: ��
OFFICE