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30189
t', APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY Q CITY Of(�UPb�RTINO RU ILDING.N,hN,C'PRICAh PERMIT NO. 30189 S O H V BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL JK ItUILDING PROJECT IDENTIFICATION t� BUILDING ADDRESS:. / SANITARY NO. APPLICATION SUBMI'TIAL I)Krl: OWNER' S PH O G' CO CIOR:SNA E: LICN -7 •- NIC CONTROLLI !gQA 'HI IF;NGI :f 'O', F:y)I LJ I ADDR Ir ❑ COMA HONE: 4/YV) BUILDING PERMIT INFO N -�a 4q C1Consultant Fees Paid by Applicant(Initial) UG ELECT PLUMB ME❑CH ENSED CONTRAC7FOR'S DECLARATION QTY ELECTRIC PERMIT FEE 1 hereby arfirm mal I am licensed under prmsion,of chapter 9(commencing JOB DESCRIPTION O d'Z won Section]000)of Divisinn3afec Business and Vmfessions Gde,and mylittnsc iz RESIDENTIAL' WOO PERMIT ISSUANCE. F-pL in full force and effect. ❑SFDWL ❑KITCHEN REMODEL au License Class LieN APPLIANCES-RESIDENTIAL ❑ADDITION [I PLUMBING RE-PIPE rFQW Dae Cmumemr (_Om ARCHITECTS 1317CLARATION PANELS (:]MULTI-UNIT [I STRUCTURAL ZOO,Z I understand my plans%null be,used as public records MODIFICATION HPTO 200 AMPS OZrM [_1 INTERIOR ❑CHIMNEY REPAIR FHF=a; Licensed Pmressimml 201-1000AMPS IMPROVEMENT K d'Q I hereby affirm ha I oro exelmDEf mCee Comucmrn License how for ee OVER 1000AMP5 [I BATH REMODEI/REPAIR DEMOLITION max)3 LL F following....(Ninon.7031.5.Business and Protest...Code:Any city ar county SIGNS ELECTNICAI. ❑OTHER ya which requims a pernnt to construct.alcor,improve,demolish,or repair my swemrc _ FLLOJ prionoit%issuancc.also requires me eppliamfor such perminn flw%igneJ gramme^t SPECIAL CIRCUIT/MISC. flyOut he is licensed pursuant o the provisions ofthe Contractors License Law(Chapter 9 111 16 0 00 (commencing with Section7")o'Division 3 of Ne Business and ProfcsslonsCdebr TEMP.METER OR PULE INST COMMERCIAL: a es= hat he is exempt eemfrom and the basis for the allcgoil exemption.Any violation of El NEW BLDG/ADDRION C1 DEMOLITION XMH Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of POWER DEVICES I]TENANT ❑FOOD SERVICE Is, nor more than five hundmil dollars(S500E F Z> IMPROVEMENT =Q ❑ Lo owwork,rhe propcny,m,isan,memployees wimwages astheir(Sec.compensation. SWIMMING POOL ELECTRIC will Jodia dex,im,Codec One Consomme, ,,kens Law does s onle(Scc.70Aa,Rusinos ❑OTHER dam nost Property who Code:The Conwcmrs Liccnw Lawdoesnmapply slfowner of OUTLETS-SWIICITES-FIXTURES property whobuilds orimprovo,such and whodoessuch work himself of Brough his own employeese provided that such mentis sold are nor intended or offered for NEW RESIDENTIAL ELECIR SO FT, m1e.IL however he building or improvement is sold within one ycarnf compinion.the SO.FT.FLOOR AREA EISA.FT. her-builder will have ee burden of proving that he did not build Or improve for par- 0,' T. rof he property.am exclusively contracting with licensed coddnors iu _ /s c swat ee project(Sec.]OCA.Business and Pmressinm Code:)The Convector's Li- asetaw does not apply to an owner of property who builds or imnmves them son. Q1 Y. PLUMBI PERMIT FEE whocoaOuO'fi 'mefipmjeca with acommem%)Icemeipunmad to the Contmemr'S /�/ 09 License Law. PERMITISSUANCE /�s k �(S Lice am exempt under Sec. ,B A,P C for his reason N�rb s7 ALT IONf her WORKERS COMPENSATION DECLARATION BACK FLOW PROTEE EVnE ) v/ ��rl/f/TrrL• _ 1 herchy affirm under penalty of perjury one of the following declarations: (J I have and will maintain a Cenifcae of Consent m slf-instate for Worker'I Compete DRAINS-FLUOR.R R 6 Cg), STORIES TYPE CONSTRUCTION Lion,r provided for ui Section J]IXl of me Labor Gdc,for ec perLnmmaa of the work for which this pcmd,is isorker PIXI'URF.S-1'F:R TRAP ❑I have and will maintain Worker's Co se ofo Ion rk for which h inquired k i Section 3700 My CorCuJsation hsurancmanceofd workfounifer thispermit isissued. GAS-ILA.SYSTEM IINCAOUTLLTS OCC.GROUP ANN Ca Workers Compensation Incumn¢curticr and Policy numlxr um: Carrier: Policy No.: GAS-P.A.SYSTEM-OVER A(EA) CERTIFICATE Of EXEMPTION FROM WORKERS' GREASPJI NDUSTRL WASTE INTERCCITOR COMPENSATION INSURANCE BUILDIN DIVISION IBES (This section^ted not bcmmplecd lfeclunnn lslinonchtmdrcddollars(5I1X1) GREASHTRAI' nr less.) PLANCHECK'ex toy any perm ee any mnanceolits t work for which0is permit i,o,Sued,lslull SEWER-SANITARY-STORM EA.21p I'1'. not employ any person in any mnnner.a,its m hcumm utnjwt w ee Wurkcrd Cnmpen. ENERGY FE Z cation haws of California.Date WNI HE HVATER W/VENT/ELECTR C Q Applicant GRADIN EE tti to NOTICE TO APPIACANI':If,alio making this Cenilictmof l?xcnrytion,youshould WN'ER SYS'I'EMO REATING I•-t s-g become sunceuoee Worker's Comemainn f rhe Luhnr Code,yonman SOILS n nmvil ha%o t ronnwim comply with wan prnvisinnxmtldsrx:r»illi snml he deemed revnkw. wnTER SERVIeIi A 7z CONSTRUC'1lON hIiNU1NGAGENCY NIiW RtiSIIIIiNTIAh YLMR 50.FI'. PAID Dare Rariptp 1 hereby amrm eat mere%n nnmwe0on lending nguncy r one peHarmaoee or C.1 Osie work for which his pen»n is issued(Sec.3097,Civ.C.) Umdcr's Name TOTAL: V LendeT'%Adders TOTAL: 'I cenify mm 1 have iced thin application wd.oum that the also in!....noon is BUILDING FE o-F-tN correct lugrcemnnnply woe all city nnJ coumy orJinnneex unJ%tete law%reW,ingm QTY. MECHANICAL PERMIT FEE V Z building construction,and hereby amhorlec representatives of this city In enter upon the SEISMIC FEE above-mentioned property for inspenina Impo v' PERMIT ISSUANCE (We)egret m-,e.indcmody and Low,hnnnlesx ec City of Cupcninn again,l ELECTRIC F E Iiahilities,juJgmems.coal and expen...which may iamy way accweagoinnt said City ALTER OR ADDTO MECIL PLUMBING E in .sequence of he grading of this permit. 1 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT AIR HANDLING UNIT(TO IQ(Xp CFM) MECHANIC LFEE SOURCE REGULATIONS. AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRU Signature o(ApplicanU(ommet Dae EXHAUST HGOD(W/DUCT) HOUSING MITIGATION HAZ RIXJUS MATERIALS DISCLOSURE Will he applicant or future building tceupoat store or handle haTmdous material HEATING UNIT(TO 100.000 BTU) as defined by the Cupcninn Municipal Code.Chapter 9.12,and the Heald and Safety Code,Section 25532od? HEATING UNIT(OVER 100d000 BTU) El Yes E]No VENTILATION PAN(SINGLE RESID) PAID Dare Receipt. Will the ircoapplicant or fumes building by the B taw ea Air a or devices which BOILER-COMP I3HP OR 100.000 BTU) mil harardous air contaminants as JcfineJ by the Bay Area Air Orality Management TOTAL: smc.P BOILER-COMP(OVER 100.00II BTU) ❑Yes ❑No I have read the haaardom reaurial% tsuWe,Chapter 6,95 of ec Cali- AIR CONDITIONER ISSUANCE DATE myuim Wilding Heald ha Safety Gide,Samna 25505,25SJJ and 25511.1 i understand mm if the NEW RESIDENTIAL MECH. 50.FT. building itimmemuwhich haves met tenant. ismya not aCelitynrte ofyvc%ccupam of the rryuirements which mum he met prior m issuacee of o Certificate of(kcupuncy. Owner or malsinced.,car Data TOTAL: ISSUED BY: OFFICE jr ---t -7 911 ol I v :�0. � � � off? �� I-• ' �� �.�, �T � �) ® = Z `n Q m O Mo (jr) r' � lI 1 /� •. . ` N I U n 1 I i 7. 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