S 3324 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPF,R'1'INO BUILDING-ELECTRICAL Pe�'1T1 NG
BUILDING DIVISION APPLICATIONA'ERA1I'P PLUMBING-MECHANICAL J 3324
BUILDING PROJECTIIII'1N I IP'ICA'I'ION
SANITARY NO CA]ION SUBMITTAL DATE
BUILDINGADDRESS,.
103341
.0 3
OWNIat'$NAML: It 2 -
PHONE: RA OR'S NAh1E: . I,ICNO: NIC CUN11101.1,
ARCIIII rECIENGINEER: LIC O: ADO(jj iza (JO''✓ ❑
Y' ab
CON'I'AC'B H( BUILDING VERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) ILDG HLECI' IM. I MldClI
LICHNSFD CON TRACTORS DECLARA 110 QTY ELECTRICPERMI'I' FEE J091313SCRIPTION
hewl,y mEon Iba I am leenod mod-provieians of Cht'nd 9(c.,Imncouins
W�2 with Section70(X)of Diviuiun i or the B-inaxx nod Putt..vions CO lc.; Imy 11cense t PERMIT'ISSUANCI? RF,SIDENTIAI:
Fz W0 111lull t'olvcand te)LrL ❑SPOWL ❑KITCHEN REMODEL
QUU hmerod Clans Lic.a APPLIANCES-RES)DHN PIAT. E]ADDITION ❑PLUMBING RE-PIPE
F Z W One Contractor
m 6 a ❑MUCI'1-UNIT ❑S'I'kULTURAL
F=y ARCO[ DECLARATION PANELS
ZQyZ I understand my plansuhali be used as public recoNs MODIFICATION
OZ-
UP TO 200 AMPS [INTERIOR ❑CHIMNEY REPAIR
FhF'W Licenxd Prow,xional 201-IfMX1AMPS IMPROVEMENT SWIMMING POOLS
OWNER-BUILDER DECLARATION OVER 1)(11 Ah1Ps ❑HATH R- :JREPAIR ODEA LITIOR
z z Q 1 hereby uftinn that I am exempt from the Commnor'x L.icensc Lnw Ln the
X 3 L U following main.(Section 7031.5.Haziness and professions Codd Any city or county SIGNS F Lfd` tICAL
W W h which requires a permit In mnermn,and,improsc.demolish or repair any suumurc
I_u'pNJ
Prior to its iouancc.aho«yuBes the applicant for such pconat to file a signet.xlammenl SPECIAL CIRCUIT/MI
RW�.� that heislicenuJ pursuant the provisiomnflbe Contractors Licenze lowlChap¢rY COMMERCIAL:
Wz�o (cmnnxmdng with Section 70gloof Division 3ofthe Business and Professions Cadc)or TEMP.METER 0 LI;INST.
2.X re oz dual he is.sero...Ihcrefmm and the W,,,for the alle,d exemption.Any viola ort of [I NEW BLDGIADDITION DEN LI'TIOS
W,-4N• Section 7031.5 by any xpplpermit
canl for a permit subjects the applicanto a
o vil pcnah,of POWER DE 'ES ❑TENANT ❑FOOD SERVICE
F,
n inure than fisc hundred dollars($51X). IMPROVEMIiNF
❑ZO Q Las owner of the Pra,rrRormy cmployces with wages as theirsole cnngnensafoo. SWIM GPOOLIiiJiCl'RIC
2 wJl du the wnrA.and the xvuctum isHol intendedorollirsd fav sole Sec.7014,Boones ❑OTHER
term
W �:Oil I f :' Code: 11 C I� I 1 1. does poly I ncr III
SWITCIEi$_I IX7IIRC$
63� P,i y I build' I' vc,II I v4ho doc, kl... II'or Ihutgh
no,Inso ruapoy,d..Pe 'ded lhal such ite,mocateral.a : l' IJrd or offered In, NEW RESIDES I'IA1.4LCCI R SQ FL :-OORAREA $ISQ PT
wle.It.ho r,Thu hnllJing or wpm rntiq sold within unc Yeur ul completion,the
cr-hnllder will have the harden of proving that he did not h tild or improve for put
pacaludc^).c `a
0 I,a of the property,a m
exclusively contracting with licensed contractors TOTAL: Aa
construct the spmjevi(Sec.7614,Business and praresions CadcF The Contractor's Li-
«Law dtex not apply to an Hasner of property who builds or i reproses thereon.and QTY. PLUMBING PI7RMIT FEE /.
who camtructs tin such project,with a«mvacmr(s)licewed pursunntao the Conown'x - 83
noaw.
Ideco lPERMIT ISSUANCE
l am escmpt under Sec, n h P C for this reason
ALTER-DRAIN A VF.NI'-WATER(EA) VAI.
Owner Dae Q
• WORKEMS COMPENSATION DECLARATION BACK ROW PROTECT.DEVICE
)hxwhy allure under penally of perjury one of,hc following dcclamlanv.
(] I have and will maintain a Certificate of Comdrutso self-insum for Workers Coattail- DRAINS-FLOOR.ROOF.ARIA,GOND' STORIES 'I YPEC CTION
quill,un provided fine by Section 3710 of Ihu Labor Code,for the performance of the
work lin which this permit is ilowd FIXTURES-PER TRAP
I Inevc:red will Inuimain Workers Com,ovation In.wramex,a,winked by Section
9]IXlofihc hal nCtuln,linl pedrrmnnccn([.uwnrk forwhicblhixpcmlit i,v insuW. -EA.SYSTEM-I INC.4OUTLETS OCC Gµppp pPN
y Wor .II P'xo' it pYu c utter and Pnliey n e
Cxlrfer Policy Nn.:h� GAS-FA.SYSTL'M-OViilt4(IIA) �
]21f1'IPICAI'EO li%hMI"CION FNO OI IiHS' CREASEIINDI]STRI.WAS'lli lN'1'BItCI?I"fOR
COMI'ENSAI'ION INSURANCIi I1111LUWG DIVISION IIiHs
1'ILix ncallnn and not beannplcicJ if the pcmlit is for unc hundreJ dulhtrs f811N) GREASE TRAP
err lcenJ
PLA AL'CK IICIi
I certify titre in the perLninance of lherwnrkro�which tnix permit is nxucJ.I shall SEWER-SANITARY-S"TORN IiA.21NIIl'.
noI employ any person in any manner m us to become xubjat In the Workers'Comp:n, ENERGY FIil3
z cation Laws nr Calilnmia.Dane WATER HIiATER W/VIiNT/ELECI'R GRADING PIAT
zApplicant
h NUI'ICIi TO AI'19.ICANf:H,after tasking Nis Cerificnm of lixemptinm,you xhnuW N'ATHR SYSTEM1I?RIiAT'ING SOILS FEEC o
; nccome whjca 6t the Workcrx Compcmutipans store of the oMm Ede You must
� ,.., Hmhwilh cnnlply with wch pmviewsmhi,iz permit shallMJeemeJ rtvnkeJ. WATER SERVICE
5Z CONSTROCDONLENDING AGENCY NEW RPSIDENTIALI'LMB. SQ.PT PAID D' Rtt'ciptp
U O Ihcrcby animtthanhert is uconstmaion lending agency for performance of
U. F' thewnrkforwhichunk,cmnnsi...did(Set.3197.Ci,C.)
0TOTAL:
Lender's Nume TO EA
r W Lender's AJAmvs
a I certily That I have read tai,application add,mte that the above iniallaation is BUILDING FEE
V] anrrco.I ngrcc to conryly with all city and county issuance,and and,lawsrclming nt QTY. MECHANICAL PERMIT FEE SEISMIC ITB
U Z nolwiltg000,malion,and hcrehy authorize representatives in In,city bearer dano(hu
nod nannoned Property it,.votpcdinn pit"'o o. PFRMH ISSUANCE ELECTRIC IT,
(We);,,led It IRIv,hadcmnily and kttp harmless ihu City of Coldillnn usual"
Ilnhll'nic,,plJglncnfn,nnlxund CKOadoeSwhlchnmymm,wltyuccruulguieslsaid City AUTER ORADUTOMECH, 1"LUMIIING IIA?
tcc of the grunting of Ihiv pennil.
APPLICANT IINUEkSIA NI:AI 'LY WIFit ALL NON-POINT AIR HANDLING UNH`00 III,INNICPMI MECIIANIGLII!li
SOURC' _L,'1'1
AIR HANDLING UNI T(OVER 10.001 CONS"IRUCI'ION"TA%
Signature of ApfickTiCounwor Dae EXHAUST FOOD(WIDUCT) HOUSING MITIGA'1'LON ITH
HAVARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant ower,or handle hamdeas material HEATING U N IT(TO 11X )BTU)
as defined by rhe Cupenine,Municipal Cade.Chapter 9.12,and the Health and Safety
Calc,Steelton 255321x)! HEATING UNIT ER 100.1X0 It I of
❑Yes ❑No VENrILAT 'FAN(SINGLE REBID) PAI
l1 Ie ReceiptOf
• Will the applicant or[.dare hitting recti ant axe equipment nr J"ice,which µ0l1 _EOMI'(3HP OR IIN)010 RRL)
za
mil haNrns air contaminants as defined by the Buy Area Air Qmality Management 'IOTAI:
Di,oin7 OILER-COMP(OVER 110000 RI'OF
❑ye, C]No
IS.,d read lhn hAleasons mardwlx requimmcnls under Chapter 6950 the Cali. AIRCONDITIONER ISStJANCE DATE
fonds Ileal ll,&Solely Cod.,Sections 25505,25533 and 25534.1, lowaad Thal it oho NI!W RESIDEN'TIN.MBCA. tiQ.FT.
bolldiog dew mtn ly htrvI, annlhaiIN, tnibililyht amity Ah,acupanl
of the rc nal `Cenlficumol'Oconpanry.
v Umu TO'CALI ISSUED fly,
nehnr: 1 tem
e
OFFICE