S 1164 4.1APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPF,RTINO BUILDING.-KLECI'RICAI, I'P MIT NO.
RWLnINc nlVlSu)N APPLICATION/PERMIT PLUMinNG-MECHANICAL 1164
IfUI1.UINC I'RfIJIiCT IDM: '1'IN'll'ATION
SANTIAKY NO. AVPLICAI'WN SUBMWI'AL DAT
HUILDINCADI nmo ,
PHONE: CONT( NAM!%` T.IC N(71W'
'��" � Y NIC ago
�� CON�'rliOLa
\' CHITECDENGINEER: LIC NO: ADDRESS: E:1y/r/g /
CONTAL . ` PHONE: BUILDING PERMIT'INFO
❑ Consultant Fccs Paid by Applicant(Initial) BLIK ELECT PLUMB MECH
✓ J K ❑ ❑ ❑
LICENSED CONTRACIT)R:S DECLARATION QTY. ELECTRIC PERMIT I'P . JOB DESCRIPTION
1 hereby aRrnt thal I am licensed under provision,of Chapler 9(commencing
aWOZwith Section 7000)of Division 3 of the Business and Professions Code.and my license is RESIDENTIAL'
O PERMIT ISSUANCE
CSF in lull force tmA cR'cct. ❑SPDW1. [I KITCHEN HIib10DE1.
aUV Liccosc Class Lica APPLIANCES-RESIDENTIALALAN PION ❑PLUMBING RII.PIPF
HGW Dam Con[ruem ❑MULTI-UNIT ❑ST'RUMURAI,
ARCHITECT'S DECLARXI'[ON PANELS MODLFICA'I'ION
~O N Z I undenland my pian,,hull be us d as public rttnrd,
O,Z r:
4: Licensed Pm(c,sional 201-1(XX)AMPS ❑UPT021NIAMPS ❑INTfiRIOR ❑CIIIMNEI'RIiPAIR
O IMPROVI;MENT' SWIMMING POOLS
[.. F
6 �= OWNER-BU1LUIiR DECLARATION OVER INTO AMPS [I BATH REMMO ON
'a a m a 1 hereby affirm Lha 1 am exempt from the Conlmemd Liceme Law for the -POTHER 0.7A
�L y V following mason.(ScdinitJllJ I.S.Buxincvs and Pndbsxinre Code:Any city nr enmtY SIGNS EhIiCTRICAI. r A��^
1+131+-ye which requires a permit to construct,alter,improve,Jen+ellsh,or repair any slmcmre
prior to its issuance.also requires the applicant for such Permit to file a.signed stmement ECIA 1
Shy that he is licensed pursuant)the provisions of the Carter s License Law(Chianas
c4==0 (mnmmmeing with Sermon 9B(XDmfDivision 3 of he Business and Prmfos...Cdc 'I P. Oh 1 O 1 T.
L d e [hit[he is exmnpt therefrom and the baxix for the alleged exemption.Any vinlalion NEW BLDG/ADDITION ❑DEMOLITION
X:N Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty PO � DBV TENANT' ❑FOODSCRVICE
m more'ban fisc hundred dollars WNW IMPROVEMENT
F=� D SN G I.ELECT
1,as mvnernOhe propcny.nr mY entploytes with wage,as theinole campenvmin W
(., will dr,hc wnrk,nnd t1warrmrc is no[in,endcdo,mLed fo-da(SO,.7W.Bu,inc L�QI'111iH
3w .rid I•rofevsionx Code:'I'he Controctn''x License Law docs not apply to un owner t ( R C11135-FI TURES
Imnpeny who builds ra improo,,,h,neo..and who does such work himself nr thmug iW NISIDI3KUA1.13LECTR SQ n'.
his own anployces,provided That such impmvements sere not intended or offered for SQ Ir[FLOOR AR i\ LSU.FT.
sale p
If,however,the huilding or immvemen[is sold within one year of comple[lon,the FEB
of
a will have fire htMeo of passing that he did not built]or inspnwc for par- 0 (T
pine of sated. II TI I'TA L: ANO'0
❑1,as my r,e of the propcny.am exclusively comraning with licensed cnmr /nst
construct project(sec.l(WI.Business and Profusion,Code:)The Contract Y�I
c xcl.awdacxnotapplymanownermfpropcnywhobuild&orimprovesthemna QTY. PLUMBING PERMIT PF:E VUl- �urCnIJpi
who contracts lar such projects with a c(mrnctnas)licensed punuant to[I C t
Licxnse La, PERMIT ISSUANCE
I am exempt under Sec. .ROf-for this s
ALTER-DRAIN&VENT-WATER ICA) VALUATION
Uure
WORKER'S COMPIiNSA'I']ON UEChARA'TIUN CK IIpW PROI'IiCf.DEVICE
1 herehY affirm under penalty of perjury one of the following dcdam
I have and will mainain a Cenificam nfConsem to self-insure for Wuree,Co DINS-FLOOR.ROOF ANIiA.GOND. SI'URIGS 'TYPE CONSTRUCrIC
ration,as provided for by Section 391X1 of he Luton Code,far the performare of
worklnrwbich this Permit hissued. 1:1 'S-PF:R TRAP
I M1avc send will maintain Worker',Compensation In.wmnce,as required by Section GAS-H 13M-I INC a( TLETS
3]110 of the Lah+rCode brt the performance of the work for which this perm i[is issuW, OCC.GROUT' AI'N
'My Work,'-Comtem: ' n trance cn 'rand Policynumbervtrt: GAS-EA.SY. M-DVF a(EA) R-- �• ,
c,adrn Policy Nn.: s
CA ItOF 13X1 ?ION FRONLIT� GREASIIINDU, AS117 I N I'ERCEM OR
COMPENSATION INSURANCE BUILDING DIVISION PLES
Obis section need not becomplaed ifthe permit isforonehundreddollanpiLW) GREASETRAP ✓• J Xs
nr Ics,.) PhANCIIIiCK FEE
I eenil'y!lou in the performancu+l the work Is),which this permit is u,sued.I shall SEWER-: NI'I'ARY-STORM EA.21X)Inf. IiNERGY 11313
na to an tan,in any manners a o bceomc subject to the Worker,'Cnmpen-
Z c alifrodo Date WATE f13ATERW ENT ELIiCIR GRADING FEC
ppf
N'I`.if, ix C Acam of Exetnpmem,you should W ER SYSTENVI REATING SOILS 11M
bennne ahac,to the Or cis Compensation prose isions of the Labor Code,you noun
s forthwith comply wilh such pilin sionsnr his Peroulahill M dt, tnwd revoked. AT 1;R SERVICE
Q CONSTRUCTION 1,13NENN(i AGENCY NEN'RESIDENTIAL PLMR. SQ.FE PAID
Dale Hecdpt If
1 herehY allimt that them is a m.soamtion Ica ha,agency lin the performance of
U - the work lin which This permit is issued(Sat.3()97.Civ.C.) 'I O'I'AL:
QLonde/,Name TOTAL:
W Lerida',Address _ BUILDING FEE
1 terdy that I have read this application and state that dm aboveim ormadon d
H to conic[.I agree to comply with all city and county onllmanccs and shoe lows adrong In Q'T'Y. MECHANICAL PERMIT FEE SEISMIC Iaili �•
V Z buildinsc...toa[mn,and hereby amhorive mprcunmtives of this city[o enn,miontbc
dwvc-mentioned propcny for inspection pugmss,. PERMIT ISSUANCE ELECTRIC FEE
(We)ag n,at save,InJemmry and keep harmless[he City of Cupcnion against
Iiabdaies,judgmmots cost,and eXPOICS which may In any wnyncemc.gaiao nail City AETFR OR API)10 MECII. PLUMBING FEE
in consequence of the granting of this hermit.
APPLICANT UNDERSTANDS AND ILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(T(1 In.(X10 CFM) MECHANICAL 111
SOURCE R 1GULATIONS.
AIH HANDLING UNIT(OVER Ie.(N)OCFM) CONSTRIICI'ION TAX
me CXIIAUST HOOD(WIDUCO HOUSING MITIGA'I'[ON FEE
FIAZARDOUS MATERIALS ASCLOSURI:
Will the applicutnor future building,ecupemtamtc or handle haurdou,matcnal HEA'T'ING UNIT CTO lmloofif ru
ax defined by[he Cupeninm Muori,ed Coda Chapmr 9.12,and the H,ed,h and Safety HEATING UNI'1'(OVHR UX), )BTU) O
Coale.Section 25532(.)! i
❑Ycs -1 No VF.NI'ILATION FAN(S GLIiRESID) PAID
m If RccciptX
Will the applicant nr furore huilding sc want use c"'ipmetn or devises which BOILHR-COMP Ip OR IIN),INN)BTU)
brow dons air ono nonan,as ildmod by the Buy Arc.Air Quality Mi nagcmcnt 'fly[AI.:
0? BOILER-C( 11(OVER 1(M.CRO BTU)
❑Yes ❑No
AIRCO HIONER ISSUANCII DATE
I htvc Safetyd the mrdnua mi ns 255 5.25533 a u255.G I pie b 9nd that
2 505.25533 a under ChuPte N 9nd thatffia Culi-
h+mia Health A Safely Cods,Stations 25585.2553)send 25531,I utdeo[aW that[if the NE RESIDFN'I'IN.MECII. SU IT.
IwildingdownmcurmntI haven ten' L[hat ilunty rcspuneihility mnotify the occupant
hater's 2104 n a n prior m is..noce of a Smificmc of OcOrpa ttcy.
❑etc TOTAL: ISSUED BY'.
J ager
OFFICE
m
A A A A A .OA A A A A A A A A .OP A A A .OA A A A A '3
1
N N N N N N N N N N N N N N N N N N N N N N N
J J J J J J J J J J J J J J J J J J J J J J J C
T W O)
J J J J J J J J J J J J J J J J J J J J J J J N
O) Q) O) O) O) W O) O) O) Q) Q) O) O) O) O) 01 O) O) W O)
mmmmmmmmmmmmmmmmmmmmmmm -i
A A A A A A A A A A A A A A A A A A A A A A A C
mmmmmmmmmmmmmmmmmmmmmmm N
000vvvv000vvvvoovvvaovvX
mmmmmmmmmmmmmmmmmmmmmmm X
m
.i
r
-1 2 2 (n A (n Z m A m T T K m A W W A O A 0 m A
A « r 2 0 r O r X m r r r mm m A m A m m
myyD M --I mpmD � nm co oDmF W FAA
� nnzG� Ar (� T (� � � = (� L� � � DrD � 00 z
z � T � mmT 7' 'n m t v
"' z � U) � N N
m
m -�{ 0
A m
Z A 0
m
j 9
cn
v
mchi
v
—+ WJ J ` —� O O O c0 c0 A A A .P W W N Nm n
O O N N N W N N (n
M M m J J J M O) N N cD (T (.n N Ut (n W W N \ m
(Dco (o (o (Dco (D 0 (D (D (D cD (D (D cD co co (D cD � (o (o co RA1 3
(O (O (O (O c0 (O m N m du m w m W W a W
Do J J � � 0 0 0 (O cD A .A A A W \ N N S
O O N N N N —�+
OO 00 O) J J J O) 0
co cD (D (D (D cD cD (D (D (D c0 (D (D cD cD (D (D cD (D (D c0 co (D 7
(O c0 (O (O COI
W OJ M CO OJ ODIM W OD W OJ aD W W O) W ry
00000nOTO- (7 (7n (7nn (7 (7n0 j
0
a.
0
C:
R.
N N W N N W N N N W W N —� N W N W W N N W (r
T T T T A "O T A T "O T A T 'D T T
N
N
T
d
X 'O 'O A '0 A A 'O 'U A 'O A z n
O
a
m
(o
C)
O