S 2535 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUI'ER'1'INO BUILDINC.-RLRCI'RIC'AI, PERMIT NO.
BUILI)i DIVISION APPLICATION/1'ERMIT rINGFE111 . iUENTiFj A S 2535
ItUIhIIINI:PRll.p?C'1'IDILNrIh'ICAI'111N
BUILDING ADDRESS,. SANI'I ARY NO. APPLICATION SUBMITTAL DA'I'I
2t�oP3 e- , 2S X376 AN7-Z- a S`7,? 2- Is4&
OWNERS NAME: PHONE: CONTRACTOR'S It LIC NO:
T!-fEw F /ti kf (!2 N/c
LIC NO: ADDREcuN'Ixol.x
ARCIiI'I'IiC'I'/IBVOINIHiH: SS: F-1 /
I--eeve- Lr
CONTACT: PHONE rBUILDING PERMITINP)
4�� 2 S-76 ^ ❑ Consultant Fee.,Paid by Applicant(Initial) nEel% %1� vI-umn_ M21
177 Rrr� -16
ET
LICENSED CONTRACIORIS DF,CLARAI'[ON QTY IiLf:C'TKIC PERMIT FITI: LJ IJ
1 hereby alarm ma I To.Ramadd under pro,cam a of Chadar 0 he'Inrn d ang JOB DESCRIPTION
Mf Z wim Section 7dlB)uf Division3ofine Husincsx and rrofes.ionsCede,and mYlianse is RESIDENTIAL:
W p O I'IiRMIT ISSUANCIT
Ca'N in full farce and ellen. O �[f Cf. SCF�/ ❑SPDWI, ❑KI TCIIFEN REMODEL
aLU Liwnsu Cl• —��U—/�-q�Cnanni �.TZ APPLIANCES-RIiSIDEN'flAh ❑ADUI'1lON ❑I'Ll1MIi1NG RI3-PIPIT
E- W Dale LLOJ=LRS
,r,ay ❑MUL11-UNIT' ❑S'IRUCIORAI.
ARCIII'I IiCi'S DECLARATION
l,-,p z IS\NI!IS MODIFlCA'DON
Op=Z landcnund my plane what,ba uwJ us puhlic aeroNs UP10200AMPM
❑INTERIOR El CHIMNEY REPAIRW Licensed Prieesional 201-1000AMPS IMPROVEMENT ]SWIMMING POOLS
CYq;
OWNER HUI1,Dlilt Ul!ChARAI'lI1N OVER IIXXIAMPS ]EAI'iI RI!MODI!Llltl!I'AIR ❑DEMOI,I'NON
C C a I hereby mann Ilial I.'it c,r rpl tram did Comma far,lams Law In,the
X
Call
U following mason.(Section 7011.5.Business and Professions Cede Any city of county SIGNS ELECTRICAL (]OI IILR
ID LL y which rtyuids a permit as 111n10un,alley,improve,demolisM1,or men,any 9mdare
prior to itsI o acquires the ppli n t forStah,conlit fl signed I t tent yl'ICIALCIRCUIUMISC.
that he licensedpursuant I d p 111 Contractors I 1' ICI pier') COMMERCIAI;
W C, ('cnn b lhSchPp 7(XX1) ID 'nniT itl It .' call f:. violation.'( I)rr H;MP.MI?'[FR OR POLE INS'1'.
6�
a L CC that hes exenttherefrtan•al the has,list hot.,,aged vxvnnon.An of ❑NEW HLOG/AU�IIION ❑DI!MUL1'i'ION
W-m Section 7)315 by an licant fora tsubjects mca,ticannn a civil Finally of POWER DEVICE. ❑'I'17JANT FOOD SERVICE
not mom man five hundred dollars(5500). IMPROVEMENT
=O S I,anwnerof the IF 1,E only employees with wages as their sole compensation, SWIMMING POOL ELE0 RIC ..
12'•= wifIdo heworkadd0eavilenic.,d tintendednndierrdfurs:Jr(See 7(Hq,❑usinexu ❑GTIH7R
co and I-o d out Cade:The Conlmchn's LiamµLaw dice,Till apply m an owner of (rt)'TLEI'S-SWI'ICHI.-FI%'TURES
3 pmrymy who builds or intpruvus mcrton,and who docs such work hinxdf ar adan M1
his own anlloyccs,provided that such imPnnemcros are fill intended ar oftcad for NI!W RESIDENTIAL ELECI'R SV 17i'.
sale.IL however.the building or improvement is sold within one year of completion.rhe SU.PI'.FLOOR AR&\ S/SV.FI'.
ownerb Id will have M1 burdenfp ingthth JJ ,halo - p for Pur d e d , 2-0
pow't1 1. r(rrnl
� p f
I. flh Pq ty 'I . vel t trot, b J ' nrvm !!! lO
cancer o the project(\a 7017 Business and l"'j,"oursCal )Me C , Its l'
n>e law dues not applyt (if property whohands oimproves,h and QJ'Y PLUMBING PERMIT FEE,
who contracts f n such projwts with a commelons)licensed pursuant to the Cama slur s
License Law. PERMIT ISSUANCE
❑ lam radial,under,Sea •1{h P C fart this reason
ALTER-TRAIN or VEN I'-WAI' I' VALUATION
Owner Duca
WORKERS COMPHNSA'IION DECLARATION RACK FLOW PRUEFECr.DEV .i /_ X D O
I hereby affirm under penalty of perjury one of the BJhm-ing dedaations: ; kSJ I/
C]I have and will maintain a Certificate ul Consent m wl6 insure for Worker's Coni DRAINS-FLUOR.ROO' REA.CO' STORMiS ERE
TRUCOOb
satins,as provided for by Saran 3910 of he Labor Cede,Ior the per(u turned of The
p work lin which this panni,is U.wud. I:I%'TUNES-I'IiR'I'RAI
(] 1 M1avu and will maiabon Warkcr's Cunapcnxmion Insurance,as required by tieetion
3700 of LaMar Code.for the affmmanceolthe work for which this permil is issued. GAS-EA.SYS'H!M-1 OUTLETS I OCC.GROUPN
My workers Compemation Insurance caner and Policy nanber arc: I I
CzOicf: Pill icy Na.: GAS-FA.SYSTEM-0 1: illi 1 Uj
CERTIFICA'I'IT OF F,XEMi'1'10N FROM WORKERS' GRI3ASPJINUIIti'TRL \.TI!INfERCF.I9Y)H
COMPENSA'I ION INSURANCE GILDING DIV ISI(IN 1i5 _
1'ILisµctionncedno.hcmmplcted if Ne penult is l'or enc hundreddol6u.ISbxf GREASE'I'RAI" B
or las.) 1'LANCII.'KF i
I dealt,than lathe performi.ceof the work for which this permit is i...ed.Ishell SEWER-SANI'D\RY-STORM EA.200 Fr.
not employ any person in any raw m beim h illi the Workers Co.,.- ENE I:P.
ma �l
ra mw
Z .noon Lawa Til coli}amia. oic /�/YDS' wn'reR nEnTT!R w/v6rcrrel.licrR
O O Applicant --=i �r��� GRnu1N Iain!
Z
NOUCH IQ APPLICANT:11,law,making(his Ccaificme of P.armption.Ynu should WATER SYS'1'IiM/IREAI'ING S( _ 'lilt
? beenne subject to he Workers Compcmmion provisions of the lab's,Code,you must
EJ.1 ... forthwith comply with such provisions or this permit shall her deemed mv.kad. WATER SERVICE
DD
p' CONS'I'RUCTION LENDING AGI7NCY NI!W RESIDENT'AL PLMH. SVP('. Dia Rcccipap
UOI harehy on ran thatmere is a.vn,anafiun Icnding nguncy I the scil undlif
E' the woo for which Ihi.)pooh is issued(Sec.30TO,Civ.C.)
Lender's Nene T AL:
O TOTAL.
U Lenders Addmss O
W 1 orally that 1 have read this application and.state that the above information is HUILDIN( I:EE
.F. N larrell l agree in roto),,wid.all city and—un,y adlmltica.aud.nae laws drilling In Q'rY, MECHANICAL PERMIT FIiE MESMI IY
U Z building,ar,manta,,and herchylmmmiro repreentalivesol mix city mama.......t ma
ahovmmantioned prolx'ay fin inspection Follows,s, PERMIT'ISSUANCE R :FEE
(We)agree m save,indanmfy and kccP harmless,he City of Cupeainu against ff��
bablliics,judgmenu.costs and expense,which may in anyway acerae against said City ALTER OR ADD'TOMECH. LUM ING FEE tJ
in nsnpance of the gmming of this peanit.
APPLICANT'IINDERS'I'ANDS AND WILL COMPLY WITH ALL NEIN-POINT' AIR HANDLING UNI I'(TO 10.01M)CFM) M(s( IANICA FFF
. 70
$OURCIi REGUI.J(TIONS.
/I�� �� XL� ,� AIR HANDLING UNIT(OVER 10000CFM) "'fRi1CT10N'I'AX
Signature of ApplicunRCnmmnor _A One f:%HAUSTBOOD(W/DUCq HOl1SIN MITIGATION FEE
HAVARDOUS NINT FRIALS DISCLOSURE
Will the upplkum of I rtnry buddingmcupom.,l or handle haaanlonsniawrial IIFALNG UNI'I'(IO 100000 15 1'U)
te ddand by the Cotillion Municipal Code.Chapter 9.12,and the health and Safety HEATING UNI'('(OVER IIX)IXXI B'I'U)
CMe,S¢fion 25532(a)'!
0 Ycs VENTILATION PAN(SINGLE RILtiID) PAID
Dadc Fired,Eft
Will me npd .a,or furore builJingnnmpo,n use egni,muld or devices which ROUTER-COMP(3HPOR 1110.00IBTU)
iia hu'rnidoux ulr connuninunt,a. it tinud by it,Buy Area Air Quality MunagenantT(1'i
Di.tda7 BOILER-COMP(OVER 111.00011TU)
❑Yes LL"o
I b J the M1 J m'alx 1 c I r Ck pt fi IS f m Cali AIR CONDI HONER 1 ISSUANCE DATE/1
film' StealthRo Safety C d S i .25505 25533 it 25134 I J a I h 1 fmc NI:W R1,S(DCN 11 Al.MEC 11. SQ.I'1', �/ ' 0
h11111 A t mol lyl , t IL f 1 ) :.hlfyl .dyi1 'cupam �C/
I,M1y rcyfi whin Ilxe f r' uuµnnu Llctlumnf(leu patsy.
e tiw5ud ly l� : b /fo DTAI
ISSUED by:
Cine aathnriemagan Dm
OFFICE