S 2667 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPF,R'IINO RUILIIINf;-RLEC'I'RACAL PFIIMI'INo
BUILDING DIVISION APPLICATION/PrERMIT PING I-ROJECII!CIIA NIIgC S 2667 6 6 7
It111L111NG 1'ROAP:1;'I'IURN'I'IFICAPRIN J v
ISUIhUING ADURT:SS, SANITARY NO AI'PI.ICA IION SORMI'll'N.UNI Ii
2z t.'s tic _T_ms
17),
OWNER'S NAME: PHONE: COISRACI'OR'S NAME: I,IC NO',
R.. _- F/a(-l"I is Cs +' — NIC ////J CON'1HOLb
ARCIII'IF.CTIENGINEHR: Bea tN7�3 LIC NO:�NCaj ADDRIF. ❑ —/ �9�
_ _ 44 t ZZ' / `
CONTACI al)yeL�V C v PHONE!: Mco BUILDING PERMIT INFO
❑ Consultant Fists Path Ey Applican(frontial) BLOC OUNCE PLUMB MI-CH
266-1463 ❑ ❑ ❑
LICENSED CONTRAC'IY IRIS UECLARA'1'ION QTY EI.ECI'RIC PERMIT I°EE
I herahy mann rim 1 mm hamsed older provkian of Chapter B(commencing AL, DCSCRII'TION
DMZ mfullarcaa 00(onfLlvi.lnnB,,fhe Insim—nd Probs,ion,Cmle,uni license;, RF IDFN'TIAL'
O wmhSection nce molNgofD PRRMI'1'ISSUANCIi p
z�F - ❑SF I. ❑KITCHEN RI!MOU{il.
aUU License Class Lica APPLIANCE -HESIDI!N'I'IAh AUDIT"ION ❑PLUMBING all PIPE
Fzm Dae Camrac
m6y ❑MUIj'1-UNIT ❑STRUCI'URAL
F.]y io
AkCHITI!CCS DECLARATION 1'ANI!LS
Z O m Z I understand my plans shall M omd as public record, MODIFlCNI ION
O Zn_ I1P'I')PNIAMIS ❑INTERIOR El CHIMNEY REPAIR
F I?F"W Licensed Prnfw,invol 201-I0H1AMPS IMPROVEMENT ❑SWINIMING POOLS
OWNER-z C 1 hemhy ifrrm tied 1 am lla mpl!Rom the C n ECLARXImo ION
License I.ow far the OVER IINNIAMPS ❑IlRGh1(IDRIIRIiI'AIR DEMOLITION
Q
y 6 U following reams.(Section 70315.Bu cines and improve.
d mnli Cvale:Any city ns caunrY SIGNS lil.l!CfRICAL ❑O'I'HI?R
113 m H which requires a permit uI esn.ane,sloes impale.h peroa.h, file
a asiig any structure
1-=�g
prima,tls ix.aancc m,n revtiirts he onpheam far such Pcrmnrorteadgned stalvnmm sncCfnE ClRcurDMlSe.
hat he is licensed pursuant to the provisions of the Cnrnncors Liecns law lChapor')
Wzp0 (commencing with Sr )lo(
twn.700Division3 of the Business andral
Pfessions Ce)or TEM P.MI?IT,R OR POLE INSL COMMERCIAL'
y y e z that he is exempt hercfrom and the basis for the alleged exemption.Any violation of C3 III, BLDG/ADDITION ❑DEMOLIT'ION
�^y Section]I111.S by any applicant for a permit subjects he applicant,u civil penalty of POWER DEVICES ❑TENANT ❑FOODSERVICE
nm more ham five hundred dollen(SSINry. IMPROVE-MI: f
2GSWIMMING POOL ELI!CIRIC
p. El
willdohewra and the structure,a not intended or offered(nrvle(Sec.T(WL Hu,ines ^
W 3 m and Prlcssinn,Cale The Cmmri Lai 1,,w
w chic%not apply to an(owner of l)U'1'LITl-SWI'ICHIN-FIS'TURI!S
pmpcny who builds or Improves Ihcmun.and whin dues such work himself ar fififinughif
his own employees,provided that such imprvemenu um not intended ar offered for N17W RESIDENTIAL FLEC7,R SQ FI'.
,life.IL lurwncr.the buildingorfmprsvementi,wld within nuc yemodenmpletion. he SQ.ET.11.008 AREA S/SQ.FT.
owner Wilder will have the burden of may ng that he did not build or improve for pur-
po"' ale) �1(y
r of the popery,am exd ivnd contracting with limned Coachman
uI
t bee Sec.]W .Bu,i 1.d and 1'ndc o btfi Code.)The Comnam'. nd 7
c Taw% .rota tyro naw dPmpeny obuilJsmmmproves hern,n,soul Q'I'1'. PLUMBING PERMIT FEE /. /1�
whnopmr, uRlrs p colli n ommnntirl heebesd ursuwtmhe Comnemr's 152
Li use .i co PERMIT ISSUANCE!
II p J .R&1'C for this reaam
• ncr Da
ATAI:CTEKR1-'LU(HAII'NR(kII'V1!CENI'.TD-I!WATER VALUATION
ORK SCOhPENrjDEC
ON
Iherebyaveli penalty ofpejry one ofhc following de) ism
❑IhvvcvJxiltrat anaCcnircacofConmmroved(-in%urtstnWrkce,Compl-
UR INS-19L R(H)h.ARIiA,CONU. ki 5'TORELS TYPO I(lN
,cion,as provuhil r by Section 1]W Uf the Labor Calc,far he perfnnn.nce of the
for which m s permit is issrcd. F LY-I'. 'rRAI'
ark
C] 1 have and 'ill maintain Workers Compensation Insurance,as required by Section
J]W of he latxx Cale,for he perfannance of the work for which this permit is issued GAS-EA.S .M I INC.J OUTLIe1 S ICC.GROUT'
My Worker's Commensalism Insurance carrier and Policy number I!R
arc: a��/� 2 C'�
Cartier. pot icy No.: GAS-EA. TIN VER 4 REA) K—3 z i o z
CERTIFICATE OP EXEMPTION FROM WORKERS' GHIiASE%INDUS .WASNI
I'IiI ' CI?14(18 ••//
CONR'ENSATUN INSURANCE; BUILDING DIVISION
or le>n.l
Ghi,aeetan need rom not be completed if the pis for one hundred dollar,(S Na GREASETRAP 1'IANCHIiCK 19
' 9;
I certify that in the Nfisdiana:afhc lark for which his permit is issued,Ishall SEWER-SANITARY-S'1 ORM EA,200 17.
Not employ any person m any manner.,,a In bealme wbject trial Worker;Cnmpm- ENERGY FEE S
Z. sntionlaxsof Cullbmmia.Dae WAT'1!HEIELRI!RW/VENI%[LECTR
C)
Q Applicant GRADING FEE
NOTICE TO APPLICAT:If,after making this CcriHcme of Exemption,you should WATER SYSTEh1/1'REA'1'ING
SINUS IZI!
(•" became subject m the Workers Compensation pent,ion,of IM1e WMm Ctdc,you must
fsrhwih lamely with...h provision nr'hi.pernit.hall he Jeclned invoked. WNIFER SERVICE! �,--/�/1✓
Q H
n' C(1NSTRUCr10N LENDING AGENCY NI!W RIM1'LI'AN
LSIUE 'IA1. MR. SQ.FT.
UQI berebyafrmIthin there is o can.,uvctian lending agency far the pertivmanceuf ecaleta
the work far which his permit n,,,tad(Sec.3047.Civ.C.)
LL F" Lenders Name '1(YfAL:
WUnit,,,Address 'T(YPAL:
'fir' y 1,oily that 1 have read this,app('a un and state that the shove infsnnahm is Rl] stip
F to locale,l agree it)comply with ml city d oumy ardinrncc,and state laws mining to QTY MECHANICAL PERMIT FEE
SEISMIC FEEU Z Wildingmstmction.and hereby amh n representatives of this city m enter upon the
u
above-mentioned Property -Now o5 opuses. PERMIT ISSUANCE! 1!LFCfRIC PHI! �O
(We)' s.' deam ypul keep hum ms the Cayof Cupeninin against
liohili' ".I a s rude i:whichno in any way acenergrint said City AIAERORADU'IOMI!CH. PLUMBINGPEF,
I ooh.
among I --p
P .I .TUN !RSTAN S.ND WIL Y WITH ALL NON-POINI' AIR HANDLING.UNI'E'(1'O 10,000CFM) MI!CHANICAL IEE
)U .HREG ,."1 S
AIR HANDLING IINIT(OVHR 10,0N)CIIM) CONS'I'RUCI'
;gran a he Con ra,, Date EXHAIIS'IFOOD(W/DUCT) HOUSING clm' ION FEE
I IAZARDOUS MATERIALS DISCLOSURE]"
Will th ,pdicamar Vlore buildingncemaunsae ar handle hafardoa,national HENI'ING UNIT'CITE 10006)It'I Go
a.,Joined b otic Copefir,o Municipal Code,Chaper 0.12,and the I Icahn:nW Sal'my
Calc.Scc1'm 25532(11' III!NI'INC,UNIT(OVER 100,1000 131
m 0 N Visit I I IATION FAN(SI NO LH RES I I II PAID Ilam Itaicipla
Will the apph'ant nr future hudding innmprno use egnipoem Aevi o,which
emit bvIf OILER-COMP(JI II'UR IINI,aNI IfI'lJ)
ardom,air cnanniounu as dl Has Arca Air Qunlipnr'Management I'
Ulericrl HOIEIER-COME'(OVER INoiniIBI'I)
[-I ye, No
le J of not rI"Rele CasmaklChincO6,91 olhCfi- AIIt(ONUI'HONEIt // ISSUANCE DNI`17.
I It him
8154 . odc,Sv, in, 551K2 .33 1255141 blind hanlthe NEW NESIUFN'I'I AL MECII. SQ171. �-.. �7 �— �'
bI'J' ly ht ve to n.Iht mihll t ......frhaI" Iun1 G�
1.cram I ran I ,I erileim'It OavpaaY,
)w crura r Uwe '1OI'AI.'. ISSUED By:
OFFICE