28637 aA"I'LIUMN I I U KILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPF.RTINO BUILDING.ELECT RICAL
BUIId11NODIVIS10N APPL)CATION/PRRIIIIT PLUMBING-MECIfANIC'AI. I'1!RMIT NO
BUILDING A DDRLSS: BUIhOINC PROJF.Cf I11R.NTIFICATION 28637
fl� r�L. ' �` ' l J Ctn aSV /y
CONISANIIARYNO, APPLICAUONSURMIITA.DATI
I O ERSNA E: a DONE 'RAC'1'UR:S E LIC NU: 9 re) qS
NAM
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I •ARCHITE� T!NGINIe L��f� -r S,e6 �IL'r'� �� r- Ntt. CONTI hM
LIC NO: AADURPSS: -�� ❑
CONTACT. O
I'IiONE; no
BUILDING PERMIT INFO J—~
❑ Consultant Pees PRM by Applicant(InhiRB LO(J ELECT PLUMB MliCll
LIC ENSEDCONIRACTOR'SDECLARATION ❑ ❑ ❑
X I herehy eflinn Ihn 1 nn licensed under Provi,iun,n!Clmpmr 9(commencing QTY ELECTRIC PERMIT
00 widf Section TlXRnof Divislon3nf the
Lrand eRecL CBanibnnnr ' N Aa
RFSIDFNTlpJsO;B
DESCRIPTION
icfexle Cl PERMITISSUANCE
1 a
Dam APPLIANCES-RESIDENTIA. ❑$FDWL ❑KITCI
FN REMODEL
X L.Dhhln ARCHITECTS DECLARATION ❑ADDITION 0PLUMBING RE-PIPE
{gin ImullsmnA my plana shall Novel.,public Actual, PANELS ❑MUUbUNR ❑STRUCTURAL
0z UPW AMPS TO 3MODIFICATION
�!�Y Licensed Profexsinnel C1 INTERIOR ❑CIIIMNEY REPAIR
K that I A BUILDER DECLARATION 201-IOMAMPS IMPROVEMENT
O I M1CRhy gfllrm That I qm eaempl Dunt the ConIm0101a I.ICen.ae Law far the OVER I WOAMPS ❑BATII REMOpJ!11y2EP lP 1 LITTON
a V !allowing rcgam,(Seminn]1).111,Budnex,end Profession,Call An cit Lr—J/V'\-
IL...,, which PY ym county SIGNS ELECTRICAL ❑OTHER
W 0 y requim a lermit m cnmtrv,l,cher,improve,dcmmlixh.nr rt air an Imdurt
.Q] prior to il,iesunnce,nlna require dnapplironl for such permiun El enx!gnednmanent
Iha,hei,licensed pursunm lathe Provisions of the Cnntrwtm'a License LawlChalnnV SPECIAL CIRCUIT/MI,C.
qAt (commeming wish Section]gp)olUivisirmJ ofthe Rosiness and Prnlexsiam Cnde)oa TEMP.METER II POL NST. COMM R IA
W tY but he i,exemp Ilmnabnm and the h ca,for the-paged eaentp0on,Any vinlgtiun o!
o Y•
Section]u]LS by any epplmma falls un ,aAbima be AnNicannu a civil Penalty of IK)WIiR UEVICI ❑NEW BLDG/ADDITION 0DEMOLITION
iNs
"At mmrt than rive hundred dollars(SJW). C1 TENANT O ❑I,nowmr of the pmPety.or my entPluyecs with wage,net Thelnnle comlensgtinn, IM 'I ;1 :( R ❑1001)SERVICE
will do the work,end the suacmrt Ls nm imm�dcd nrnncred lm sale(Sec.]44,Business IMPROVEMENT
end Profeuhm,Code:The Cnntrwmrx License Law does not Apply 10 an owner of I -.WI ❑OTHER
prnpeny who build,,,,in'TA-11 tbereen,and who doea Inch work himself n thantgh %PURLS
his own empinyann,prnvidtd flet such immavemenn era not intended or.bared far NE SIDC;NII CL1!CTR SQ PT.
sale.If,however,the building or imprnvemcm i,mIJ within one year ofcomPldian,the
ow enbuilder will have the hualen nlPmving That hedid nmI ldor Improve for pooV SQ.FF.FLUOR AREA SMQ_IT
Pnre or s.1,T.
❑1.ax o saner of the pmpenY•am exclusively contra sing with IicenaeJ contractors to TOTAL:
nnrvm the Pmjeet(Sec.70L4,Rmine,r and Pmrersioma Cole:)The Contram
rrk Li.
cense law dors not apply town owna.foupuny who huildr or improves thereon.end QTY. PLUMBING PERMIT
whoeoomma"nrsuch Polesuwith acommcvvfa)Iirrnud pursuant to The Con9amr. _ B_
License Lew.
❑Iememunfaunder Sm. .R&P C lar this rtamn PERMIT ISSUANCE
I Owfrcr Data ALTER-DRAIN&VENT-WATER(EAT
WORKHR'S COMPENSATION DECLARATION VALUATION
1 hereby.demo under penally of perjury ane of the frllowing de,arnian,: BACK FLAW PROIHCI.DEVICE
I have and will maintain•Ceni Bcam of Cnnaenuo.eff Inure for Worker'a Cum
sethm,as Provided fur by.Section JAM of The i<Mo Code,fnnhe perbmmnme ofThe
r. DRAINS-FLOOR,BOOP AREA,CONU.
A, fm which Thi,permit Is is - STORIES TYI'BCONSTRUCTION
❑Ihoveand will mainmin Wmker'I Cnmpenwfion lnmmnce,as rcgnirN by Section FIXTURES-PER TRAP
5]110 of@e LeMrCnde.lnr@c perfnrmgme nl the wmk(mwhlcbdd,permithhAAnl, GAS-EA.SYS'IEM-IINC.4OUL'LRIS
My Wrnker's Compensation lmmmA,,Aaerand Policy mm�her art: (ICC.GROUT' APN
Carder: Policy No.: GAS-EA.SYSTEM OVf.R 0(EAI
CERTIFICATE OP EXEMPTION FROM-WORKERS
COMPENSATION INSURANCE GREASPANDUSTRL WASTE INIERCEPTOR
(This.attfinn reed nm hecampletedlithe permh h forme hmdreddolhu,IS OU ,., 111DUINODTVI ONFEES
nr less.! GREASC TRAP "'
I cenily thef in Thr Perfwntance of fbe work Gwwhich Chir Permit it iwuN,I,baa PLANCHP.CK PER
z net—Play Anypawnfunny"A"an as iso becomuobb,cl In The Walk...Com'.. SEWER-SANITARY-S'I ORM EA,HFI IT.
I..Lewx at Cnli r...is Date [NERDY D3
z�0 Applieem WATER HI!ATER WIVENTIELECIR
r%J NOTICE IO APPI.ICANI:IL aper mekmg Thi,Cmificam of F.aempinn,you should GRADING
become suhjm to The Wnrker'a CnmPmnminn Provisions Al the Labor Cale,you mmt WATER SYSTEMnHEATING
fmhwith comPly whh such Prmidona or this Permit,ball be deemed revoked. SOLI S ITE
� e WATER SERVICE
Uz CONSTRUCTION LENDINOAGENCY NI!WRCSIpF.NTIALPI,MB. SQ,PC p
0 Ihembyefrimolhm llerc is Aronetrvninn lending egemy Ge the pnhmmgnce of
0{'•, Le wnh hn which dda Permit is ilaued(Sec 3M7,Civ,C.) m Rm try a
0C[1' IandcrsName
}}tt Lender'.Addrev TOTAL:
Lr ly Icrtifythm l have read this-PPlicadon end ,.,A he,fheahuva infonngion ix TOTAL:
iLrr& bTYL PEE
Q correct.I agree In comply with all city end county noillum .hind ,At,lnwe rcladng to BUIL �s
V❑ building construction,and hembyamhrrixc"Prcmnmtivea of this city to enter unthe
' MEC�IAN�CAL FERb(Ij'
ahnvcmcalioned property lm inspection PoTaacxPn
. l SEISMIC FEE
(We)agrce to save,indemnify and keep hanalea,she City of Cu,,ino ngninq PERMIT ISSUANCE
Iinhilitirs,Judgulants,tuns and ex Musa,which may In any way wane again mid City ELECTRIC TLE
A raoaegtenee of the Small,of IN,permit. ALT ER OR ADD 10 MECH.
APP ANT UNDER 'IANDS AND WILL COMPLY WITH ALL NII-POINT PLUMBING FEE
-,RE ULATIOI S. AIR I IANDLINO UNIT(TO IILont,CFM)
( I*
CONST UCTIGNT
s Alit HANDLING UNIT(OVER ITLHAI CI'M)
Slgnmurt sal,PPI oalra r CUNSTRUCfIIJN TAX
BAZARIX)U$MA TERIASDISCLOSUR CXIIAUST IIOOU(w/DUCf)
WIN Theapplicma m Inure building or'cupnnl alum or handle hmnnlou.mmnrIIIf!ttIING I/NIT(iT)IIMLOMI IT
Code, HOUSING MITIGATION :E
As derfncd by she Capetian Mam'lPd Code,C11-1111 9,1],IM the Health and Safety
0 y.25332(.)? ❑Nn
❑Yen BEATING UNIT(OVER 100,0011 BTU)
•
VRNL'ILAI'ION VAN(SINGLE RPSID) PAID
Will the applicant m future building by the B,use .Airmnt m dM Al which Uatr Be, iPt R
harnMnus air con,emingnln q.v define)by The Bay Arca Air Quality Manngen¢gT BOILER-CUk1P(JIIP OR II110T10 RTU)
ntk17
GY" (D No D01LER-COMP(OVER In ow BTU) TAL:
I have real The haraNnr,nmmrials requimmenm under Chapter 6.95 of the Call. AIR CONDIT IONER
Tante I led"'&Safety Cade Seconal 35505,8533 and 255.14.1 undersmnd that if The ISSUANCE:DAT E
building clue,not currntly he,,A,A..,.de,It is my rcarymalhility In notify the eacopm, NEW RES IDEM IAL MCCI I, SQ.IT.
of the rtquimmenta which must he nes Prim to internment.Camil me of Omupamy.
On tutor malas vl agent
Dae TOTAL:
ISSUED BV:
_ —_. Bunte