S 2298 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUI'ER'1'INO [,Oil NG-EI,KCIRICAL PERMITNO
BUILDING DIVISION APPLICATION PERb1IT rINC PROJECT ICENI IFI 1. Q 2298 2 A O
IfI11LDIN1:PROJECT IDF:N'1'IN'ICA'I'IQry lJ .Ep O
SANITARY NO. AP1'hICA'I'IDN SIJHMI'l9nl.UAI'H
BUILDING ADDH6S5'.
olq-2- �¢ vtirl �i � a!�✓Ip /v G sY
OW�NE:II4'StNAME: ON2 9., TRACTOR'S NAME I.IC NO:
•Q NIC CON'T'ROL#
�IRCI II I'E'C/ENG NEI: ICN(: ADD F_SS. ❑ 91010
0
CON'InCe: PHONE: BUILDING PERMITINFO
2 S -? 3 G Qi ❑ Consultant Fees Paid by Applicant(Initial) ❑LDG HIIECt PLUMB MECH
o- o- e- ❑-
I.ICENSED CONTRACTORS DECI.ARA'rm QTY ELECTRIC PERNIIT FEIi
I Inch,mr m Inas I am licensed model p,,1ona ofchapmr 9lcommrnring c��` JOB DESCRIPLION
QWz 1h Sella....9lXXp of Uivlxiun3,folio lfusincssand l'm2.aienx 0sle, stn,licca,is SJ V RE,SIDENTIA1,
wo 1.17RM I'I'ISSUANC17 J I V
��F� In full torcc and ulfu, ( r ❑SFO h ❑KITCIIIiN kEM(1DI
Licen!2#47--'4-?(
se[ f hi In c Xap�-{,n r APPI.IANCES-RE.SIDENTIAI, DI'rION ❑PLUMBING HIiI'll'li
m Cnmmcmr
ARCHITIiCPS 1)ECLARAI'IONYANIi1S hI❑MDIlI1 DNIT ❑MQDIFlCATIONUCP TIO
Z O m Z und,roand ely ph,p shall be uwd aI public records
OZ=-a UP10200 AMPS ❑IN1'Ii1HOR ❑Cl I IMNF,Y REPAIR
p+y,17 uJ Lieeroed Proo,ion:d 201.1000AMPS IMPoVEMEN'I []SWIMMING POOLS
OWNER-I ILDIiR DECLARATION OVER 1000AMPS [3 BATH RE,40DHIJIFEI'AM ❑DISMOLITION
IY C Q 1 hereby anion Thal I am exempt from the Contractor's[.keno Law for the
yay� i U follow n.ESeelen 70315,Business and Prefer nc Cock Any city o county SIGNS ELF,CIRICAI, QTIBiR
00'3 W y which is pure.a pernrn le congmrl,Idler,'reprovq demolish,or repair any or
w
F-�0G prionniTa lssuancc,aPoo rayuirec the ayrplicunt for such periniun(ilea xigneJsmtemaot SPECIA1.CIRCJI'1'/M F� �
i_ That he is Berard pa,wunun the pro simns of the commerot's License lrw(Cnmte`9 COMMERCIAL:
1�a1�00 (commencing with Section]IXM)of Division 3 of the Business and Profeaciom Cadet(IT ITMI'.ME,ERoRpEw1
1 k M thus he in exempt therefrom and the bask for the alleged exemption.nIy..elation of ❑NEW BLDG/AUDITION ❑DIiNOLITION
Secmel1011.11.5 by airy applorma for a panne subjects the applicant m a civil penany of POWER DEVICES ❑TENANT ❑FOOD SERVICE
a, rotor... on hlive handed dollar,($500) IMPROVEMENT
Sp QLus owner of the Pngeny.or my ennployees wiTn wager us Neinnle ennpcnsalinn, SWIMMING POO],1!LECTRIC
❑O'DEER
F. will Jothe wod.,and Ne smuc.reisnm lmemJNooffered fm dc(Sec.7(W.Business y
L 3 m and Pr leusiona Code.ITc Commctor's I.iceuse Irw Jarsnot apply man—.1'If 2 OVI1X7S-SWI'I CHNS-FI%TURE.S t 1�
property who builds..r inrpmve<Thereon,and who does sura work himself or Through
his own empinyeca,provided Nut such impm vewles arc mol in one cd o cured For NEW RCSIDCNI'IAI,Ii1.CCI'R SQ FI',
,ale.11,bowre,,the huildingor imcm
parvmnt is sold within one year of coinfection.rhe SQ.PC FLOOR AREA $ISQ,IrI'.
owner-budder will have The burden of proving that he did not build(it inmmen for per-
It sa1,). TOTAL: y
1 m f Ili property exclusively T liy Th sed contrector,inn _1
construct the project S 70,14 Hostile,, To P jcy,jor,Coric:)'Fic Contractor',[.I-
u
I 1 I apply ly t Id p I ty is9 bri IN ' P : Inavan.and QTY. PLUMBING PERMIT FHE yy IT X 94-1-u
who urnocae for such projects pill aunnrauor(s)licensed Perspire it)The C t is
I.iceme Ire. PERMIT ISSUANCE
❑ I ane escmpl under Sec. .B&PC for this reason y ssu6 Ff0
AEI IN-DRAIN.@ V HNT-WAFER(EA) VALUATION
owner Dale G li
WORKERSunePenalty
of Krjur on OIiCe following
HACK('LOW PR(YI'ECI.DEVICE GAS— Jf,
I hereby efEnn under Penalty of I<rjury one of the f,llms'ing dcdnnlinns: J
01have and x'ill mtimemna Certificate mComem or wlf-insure far WurkdeCmpsn- DRAINS-FLOOR,ROOF.ARE&COND, S'P(IRIFN TYPE OMT�ION
sat :provided for by Section AIX)of theT 1 h Code.r thePerformance of The J
nkl ti hthi O' t :',. J I'IX I'l1HF_S PER TRAP t� I �p�-
I l 1 'll nu I W k :Co I I' I alt : J by Seci o n
391X1 III the I M CIO t tirefaf nam III klewh'Idik vaimlix issued. GAS-I:A.SYSTEM-I INC.40U'fl.E'1'S OCC.GROl1P MIN
My W,ukv� m nauan Insurancecomer and Put icy nuNfef �. /// O(1 LA,SYS'Dihf-OVER 4 UA) n 3Z(G
Carrien_o� ll f Policy NO.: /c. 7X GAti_ s " Z.�
CERHIT[CNI i OF;EXEMPTION PROM WORKERS' CEREASFJINDUSTRL WASTE IN HiRCEPTOR
COPITNSA'1'ION INSURANCE BUILDINGDIVISIONITS
(CIhis section ncndon,M1eI..nplenrd if The Psoril i.I Europe hanJmJdell.is S 1 go GR HAS);TRAP nFT.Ej
63,�...ed.1daill S "k-S -STORM I'A.200 ET. e!not employ any permit in any manner.a r as m borne otbjecl m The Worker:Co.,.- ^ \ /ZD .Z s:niull larwx of Calik...i:,Oats "Ili ':R N4zApflinamN0110E'IDAPI'LICANI':If,al¢r making Nis Ccniliectc of Exennftion,Yat shouldMenne n.bjectanthe Worker's Compensation provilioa of The IrMr Cooeyou mull _fonhwith comply with such provisions or this permit shall M deemed revoked. WA' { w ( 1 ����/zCONSrRUCI'ION LHNUINOAGY,NCY NI RESIUICN'rIh I'LM S Iemcipl#UOI MrcbynlYnn thatTnemrs r e wow iron lending agency Ga the perfonmervolOF the work fur which Nie rrmnn I...cd(St.3097.C.C.) '� 'Dl'I'AL: rC) U Lender's Namew7vr Lcndcr'x Addrrss Li y
a I eenny thea I host,rend ani.upplicanen Imd.Tate that the above Infomwluel as
Fy cme.Ixgrecto comply with all eityunJ county ordinances and.mate laws relining In QTY. AN.ICAI,I'EK FIiE4 SIiIShflC ITT.
U Z build ingon
csonaion.mod hereby meharinc represenmtives of Niscity m cnl"Inionahc
aMve-mntiuned property for inspection purposes. PERMIT ISSUANCE[ T7 EI-ECI'RIC PEE 59,
(We)agree m save,indemnify and keep hapNen the City of Coloration against
Iiahilill....adgmnnn,eosrc and cnpenscs which may in any way accmc against said CITY O A1:1'1;R OR AI NEC iZZ-013 PLUMBI iE 6gr
. tceyemmc IF for gaming of ahinpcnnif
APPI.ICAN'I FINGERS'I'ANDS AND WILL C11hlP1,Y W I11 AL1.NON-POINT' AIR IIANDI, G UN1'r(TO 111,(NXIChM) r1 MliCll A 131! �1qr
SOURCEBL ULN'IONS.
./ AIR HAND NG UNIT(OVER 111,000 CFM) (11 CONtsr 10" \
Sign:nurenMPPlicuntlC,nTmt101 Dee 1:'HAUS'r IDIOM Wf
'It J Jl ton-, li HOUSING HK 'HE F '.
IIAZARDOUS MNIIiRIALS OISCLOSURI! rJs7�
Will the uppli,motnr[murc tainting«cupam marc or M1anJlchvnrdouc momrinl 111?ATINC NI'pTO10E0p BI'U) �Z Z
as defined by the CupnCo
ino Municipal de.Chapter 9.12.and the Ileahh alrJ Safety IIISAI'IN III OVER100.000 BTU)
Code.Section 25532604 _ 4
[:1 ye, ay ' VIiN'I ILATION ElN(SIN I PAID •7LJ1T_.ref
!/ Doc Perry,it 7�1191JC$f
Will The a,plicnm,r more building oecuparl enc cyaifmcnt ur devices which BOIL(;R-COM P(311P OR 100.0n)BTU)
emit h rrardoec air contaminants us defined by The Buy Arcc
Area Air Quality Managennt TOTAL:
District9 BOILLR-COMP(OVER 1100,0000'N1
❑Ycc
AIR CONDI'IIONI:R ISSUANCE I) 'E
I have fled Inc 1Code,S s tions 55 5,25533 anogreenout,nndnt Cbupnd b 95 of he Calk k/`OJ/yfe/
hunia Ilcahh&luliTy Corte,Sections 25505,25533 and 255,1.I understand Nut if the NEW RISIDENI'IAI,MECH. SQ,IT. O
building inn currently have a moan,that iT is my ne".ibi IymnuifytMaecu',up
of th u s t phmustM l , .,it to iesuanccaI -T of Icy. / �r� yI
�'� TDI'AI,: /p s7Q ISSUIiOny -I)C!, Hx7'
Dwp,�ul nria�ngnnt Ualc
OFFICE