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S 2121 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPEwrINO BUILDING-ELECTRICAL 1111911 No BUILDING DIVISION APPLICATIONXERMIT PLUMBING-MECHANICAL 212.11 1 ROILDING PROJECT IDENT'IF'ICATION' BUILDINGA UDRFSS, SANITARY NO, APPIJGgION SUBMTITAL DATE D�� ovc�ri�G-�z ,i v� CUM1- CRR • 1 N'!:' r � � HONE_ _� CONTRACTOR'S NAME: LIC NO:S aha ARC111T1PCf/ITNGINIiIiR: LIC NO: ADDRESS: El❑ CONTACT: PHONE: BUILDING PERMIT INFO 2 • ^3�� ED Consultant Fees Paid by Applicant(initial) BLDG IiLOI' NABOB MOV S LICENSED CON FRAC ORS DECLARATIONQ HY ELECTRIC PERMIT' FEE 1 hereby amort mal I ant Iiceused under provisions of chapter 9(commencing JOB DESCRIPPION W pZ with Section 010X)of Division 3 of the Business and Profcss6ms Cade,and my license is RESIDENTIAL: O PERMIT ISSUANCE U F in full force and effect. 0 SFDWL ❑KITCHEN REMODEL QUU License Class Lica APPLIANCES-RF,SIDENUAh ❑ADDITION ❑PCOSBING HE PIPF F Z W Dam Cantmcaar m Q 6 ❑MULTI-UNIT [IS9'RUCI'DEAL "' '=tai n ARCM IECPS DECLARATION PANELSMpDIPICAI'ION Z O h Z 1 undcrswnd my pl:oms shall he nscA us pnhlic records ©/ OZ�Q UI"I'02fX)AMI'$ ❑IN'rl?RIOR CIIIMNITY REPAIR F.�t:W IJccmdIt lssiunulillI 2111-1100AMYS IMPROVF:MHN'I' E]SWIMMING POOLS yF Q J OWN -BUILDER DECLARNHON a C C mn an!mn that I .in-unn,a I'r an Ise Commnar's Lacers,Law liar Inc OVITR Ins)AMPS 0 RATE NITMODI?LIIXI:I'Allt DI?MOLITION nc Q 3SGV duh awingrc a(Section 71111 to Ii,alley ,p lve.d us Ca dc:Any coyo county SI(IN$IiLEG'IW(lAl, ❑(YI'1{I?K 1n y whiclm reymrea al len:ta m canpnxn,arlenn'mmpmn,denmfi%n,or repair am nlmuare clRcu Fun',, prat t t,'.. l I 'tl J pn1 n npc a II �g 1.-tale ban srrSPECIALn/MISc y that lai isI'seen,ld sillocal to'he p 1 tl Contractor'I La (Cha ci,'9 12GO (co gwith Sect 710X) rlJ 7 td b .- dV f.. :Cade)nr 'IBM R M h rhR OR POIX INS'1. COMMERCIAL: a ILe C that hIha e is exempt eretr n and the basis home alleged eaemptmn.Any vadid on of Ll NEW BLDG/ADDITION 0 DENIOLI'1'[ON x] a, Section 70315 by any applicant far a ry man wheals the apan plicl na a civil pe+tally of POWER DEVICES not more than live hundred dollas(S51X). OTENAN'P ❑ TOO])SERVICEFZQ I.aeaal,rofthe n In with wages their vale cum tion. SPTAIMINO POOL GLEC'TRIC OTHER IiMIiN'1' W=Q (] prose y,ar lnycnip intended wi gas as pease E3 OTHER C F e will da mesion.and the%he Co misto-not wnensc Law wowsred no;apply w an owner of C�m and professions Coda The Comrucdot.Licenu Law dans not app1Y to an owner of OU'FL61S-SWITCUES-FIXTURES pmpery who build%or improves thereon,and%he does such work himself or through his own employees,provided mm such un prove Ivan,am nut amended or uttered for NEW RUSIDENl'IAL HLECT R I'. sale.If. m however.the building at inprovccnt is sold within one year ofcompletion.the SU,FT.FLOOR AREA SISU.ET. nen W ilder x ill have the burden of proving that he did not Wild or improve for pur- po.c of sale.} en r+d the propY.+ esd nn a<ivcontractingycontractingn <ting With licensed commol%da O 'Let the project(Sec.]IPJ,liminess and Pm(essinro Code:)The Contractor%Li- nwLaw does act apply[it anowner ofprogeny who build%or improve%thereon.and QTY. PLUMBING PERMIT EE who contmes for such prcjc0%with a conlrrm Of licensed pursoam to the Contractors License Law. PERMIT ISSUANCE C]Ism e%cntpl under Sce. ,B&P C far this noon AIXER-DRAIN&VENT-WAT ER(EA) VALUATION u Date si WORKERS CONJI117NSATION DECLARATION 13ACK FLOW PRO[ECE DEVICE M O V O 1 hereby Idlirm ander penahy of perjury ane of the fallowing decWfmiom v 0IM1avcunA will nwinlnmaCcrtilinncof Can%cnlmnelf-more lot Worker'I Camaro DRAINS-FLOOR,ROOP A It PA.COND. SIO His TYPHCONSTRUCTION ,alien,Its provided lar by Secllan 370 of the Labor Cade,for Bre perfmmaace or the work liar wM1lcn Thi%I'm lis isnucd. FIXIURES-PIN'lllAP El I have 1 1 will Taimou.Worker"Con.p....tolon Insulate ,an reyairud by Sealinn 37B)ot the Lahnf Calc.Bartle,I'm lornualecol he work farwhich lois permit is lxnuenL GAS-Ir.A.SYS'H:M-I INC.JOUILC'LS OCC,GROUP APN My Worker's Cnmpeo,nion honnmec tel ls'and Put icy another arc. Carice Pals No, GAS-ICA.SYS'1'17M-OV 11RJ(EA) CHK I'IFLCA1'1:01'FxCIA PI ION FROM WOR KERSORHASE/INDUS'I'NI,WASI'BIN'I'F t" IOR COM I'ENAI S 'ION I N SURANCE BUILDING DIVISION FEES _ (I'his wctionnred not bccamplceJit'the pormit is for one hundred dollars($Nq) GREASE TRAP or less.) N I TEE Icertily that in lhclarlbrmane—fthe work ticwhich this pmnn ixineu.d,1s11a11 SH I:R-SANI'T'ARY-S'1 ORM IIA. i 3 not employ ally person in any nn nanc s)as loWeamc object m cone Wooer: pe Coma- 3R( Z anionn of California.Dom WAr1iR HIiAIER VOVENDELECTR GKADINGFE Z lawQ Applicant = NOI'ICH TO APPLICANT:IC he,making this Ccrifmcate of Exemption,you should WAFER S YSIPM/I'R HATI NO a > become subject to the Workers Compensation provisions of the LaWr Cade.you must fanhwith comply with wch prnvisionv onM1iv permn shall be dcemd revoked. WATER SER VICE Y 7Z CONSTRUCTION LENDING AGENCY NEW RIISIDI' T1 vNAl.i'LMB. SUIT PAID at Rcecipta V 0 1Nrchy aRimnhaunerc is o co.,aWe;ic.lending agency Initial,pmfnmlaric,,of — he wink for which this permit is issnoil(See.309].Civ.C.) Ler dds Name TOTAL TOTAL: U Lender's Address 1 Oct ify that 1 have read his application and state Ibar the above information is HUILDINC BIH r' � pp correct.lo,rev m stonily with all dry and county ordinances and state laws relating to QTY. MECHANICAL PERMIT FEE SLISMI EE V Z buildmOamstfuction,and hereby autlano.semewna,wesafth.,city wenwr upanlhe uWvcmcntioned priTedy for inspection putryawc IIERN11T ISSUANCE ELECI RI 'FEE (We)agree na Hove,indenamify and keep hannlcs%Ihe City of Caperton against Iiebilitie,md,nun..caal,e and,,panscv whahmay in anywtyaccm,tiour,licid City ACF HR OR ADD'10 MECH, PLUMBIN( lilt in mro,maea1'the b,I ingot lids pernil, APPLICANT'ON BURS]ANUS AND WILT.COMPLY WITH ALL NON-POINT AIH IIANDLIWI UN1'I(%0111,100 CFM) MITCHANICAI,ITE SOURCE REG1ILA'HONS, AIR HANDLING IJNI'1'(OVER ltklNNI CPM) CONS'r811C'1'IUN'I'A% Signatmmol'Appllcaim: nom Dat, 17XIIAUS'I'IO()I)(W/Ol1C'I) HOUSING MiI KA'I'ION]THE IIALARDOIIS MAI ERIA1 S DISCLOSUNE WIIIIhe uppl'leanlnr Inion,hulk ingoceupem nt cot handle haianlem,ri I IIiAI'ING IINI'T fTO I do dao B-]H) m relined by Lha:Cupcir Municipal Code.Chapter 9.12.and the Health and Safety Cade.Seclion 25532(0/ HHAFING UNIT'(OVER IBUXX)BTU) �Yr% 0 N PAID VIiNI'ILA I'ION IsAN SING LE RIi$ID) Onc Heeiptp Will the applicant at future huilding occupant use e,tinparem or devices which BOILER-COME'13HP OR 110.1X0)BTU) mil hamrdous air conwminaae as defined by the Bay Arca Air Quality Management F O District'! BOILER-COMP(OVER I W.UBB BTU) ❑Yen ❑No I have read the haaafdnu%maferials reyulr<nwau under Chapter 6.95 of he Cali- AIR CONDI HONER ISSUANCE DATE home Ilcalth&Safmy Cad,Sections 25505.25533 and 25511.1 umkrstaad that if the NEW RESIDEM"IAL MECH. SQ.FT. building dans not currently have a tenant,that it 1%my resrymsibilily m notify the occupant of the myuimnents which hand W net prior as issuance of a Cerincatc of Occupancy. Owner or authorised agent Date TOTAL: ISSUED BY. ` f 0 OFFICE