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S 2772 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUI'RR'1'INO BIBIA)ING-ELNCTRICAL li F NO. ItI11L11FNG n1'RrvOrJE-LMTE BUILDING DIVISION APPLICATION/1'ERMIEEt. IIIEN'I'IFIGk'1'10N9i C 2772 772 SUIMITA. DArl BUILDING AUUXCSS �arno SANITARY NO. AIILIAII( os ©s PcNr sV� -5 26 -Y? OWNI:R'SNAMI3: I'I Il1Ni? LON'IINC'I'ONS NAM(!: LICNO.. NIC �7CON'I1tOLX �ARCIII'1'1!C'VICNGINI!I!N: I,IC (1: ADDRESS: ❑ 7 CON'T'ACT. PE: UONBUILDING P13Rh11'F INFO 1VONCy 49 It—706 Consultant IT"Paid by Applicant(Initial) ULDO HILH0 life nue r7 I FJ ? LJ LICI!NSITD CONTRACI OR'S IM-CLARATION QTY ELECTRIC PERMIT FEE I mushy a1Gmt mmm al 1 am licensed under provisions Chapter v molnm ng ]013 DESCRIP'T'ION aeaIZWO, with Srai...17(XX),o1D,,Polon 3otlhe Business anti Protesnionx Gds,Ind my license in pERMI'I'ISSIIANCE RESIDENTIAL: li-,Ek= in full force and effcm. ❑SI' WI, [IKI'I CHIiN REMODI. QUU Lircnsc Class Lica APPLIANCES-RESITHNIIAL AUD]'110N ElPLUMBING 107-111111:H z W Da¢ Cnmmmor 'baa' ARCIII I'eCl'S UIiCLAItAI'ION ❑MULTI-OMIT ❑S'I RUMORA[. ~rriZ I understand my pIms,h.II heuwdaspublic rcands IANLIS YIODIRCATION p.Zr3Q UPTO 200 AMPS ❑INTFRIOR ❑CHIMNEY REPAIR P, Fe Licensed Pmmminnal 201-10y)AMPS IMPROVEMITN'I' SWIMMING POOIS CYaj (IWNEWBUILDGR DECLARATION MRWAMPSS ❑BATH REb10DIEJRRIIAIR ❑DIiMOLI'I'[ON a ¢ 1 heresy.flirt!!That I mo exempt Irons me cotvactor.Littylne Law for me xq L U following reason.(Section 911]1.5,Ifueinexx and Prof..ions Code:Any city nr manly CAL ❑(YCIIITH aE'- which npuims a permit at comwct,alcor,Improve,dean or repair any strucmrc; rotor,,its issuance,asortlian,theapplic:mt haunch permil ,,fileusigmeJsta¢menl ITIMISC.do her,licensed p.,Iran'n,'lot rovlslnns nl the Cnmruclor',Licmue Luw(C'hupmr1) CQVMPR 'TAI' I+IC, (commencing with Section 7M))trDivision Jofthe Ru%inc%svnd ProfssinroCodi R DOLE;INS'T.q y mal he is exempt mercfrom anA the basis for me alleged exemption.Any vinlmion of :W BI.DG/ADDITION ❑DF�\IOLITION W�ySec0nn9031.5 by any upplicein for a permit sobjab thcapplicant In n civil Pcnahy of IS ANI' 0FOOD SERVICE; m Inure than five hunded dollars($500). IMPROVhMEN'T =p 01,nonvoter ohne prmmrty or my employees with wages as their sole con+pe.ation, SWIMMING POOL BLICTRIC will Ju mework,and the slruclum Is nnI inlcndedIrl'o118red tot sale(Sce.9d44,Rasions% =FILk m W3— andP Professions Cm ThContractors. 1' el ❑ sl.,Ply cr of (IDI LISTS IN IICIiIb FIX(URES propenr who holds P s th J h J n cook forest Ihmugh his ow ply : P t J J li1 . I I I ]not fl d fir NLW RUSIDLNTIAL EI.LCIR S sSQ,IT,I LEON ARBA I$Q ale 11 1 r M1 b II gPc I IJ 'Iti eyear 11 l Jac / /- 7rpr her hu(der will have,the burden of putting that he did not buil)nr'mpn c 1 r par- / -76� V " P^ L as of the progen,o sdusi and Pommeling won contraccontractorsi- , licensed contractors orr.Irnet meeproieet(see.'IaJ,Besinex%and Prnrex innscede:)The commemrs Li- 'so se Luw d.aa sol apply to ao owner of properly who hold—,improves themon.and QTY. PLUMB( 2h FEF. Q �(�( I' whoc:mtracu h+r such projects with a conlmcmr(J licensed pumuanllo me Contractors �� ( Zo/Qrap License law. PLRMI'F ISSUANCE 1 ❑ I sen cxanlpl under Re .B k P C for this no,om T— ALI Bit-DRAIN&VENT I VALUATION Date sant WORKITR'S CO `ICN SANON DECLARATIOI BACK FLAW PROI'F:CP.DL CL Jt O 1 hominy athmt order pen. y ofperjury one of Ise bolowinR Jedaratlmss: C/ ❑I have and will maintain tiCertificamof Comeln toself-avam for Worker's Compen- DRAINS-FLOG ( .CONU. STORIILS 'TYPIC CONSTRUCT]ON .vtion,',,ian iJed li+r by Seen un 370B of the],;.No Calc,fur the 1<rfnrrnoncc of ton work lin welch this to I,issued. V. 19X'1'111!GS-PIiR 1'RAI ❑I have and will maintain Workers Cnmpcnvtion Insurance,as recanted by Section 1900uf the Lob...CoIs,fur lee lerfomwnce M the work for which this permit is issued. GAS-13A.SY.'IEM"I INC.] My\V act Compcnsalion Dominica currier and Policy mmnthdr am: GAS-IiA.SY ' "OVH J (I Carrier: Pit icy Na: CF.R'I'119CATli OP EXICMITION FROM WORKGNS GkICASPJINU ,WASTE INTh:RCEITON COYDITNSA'I'ION INS 11 RA NCI; BUILDING I IIVISH III IThisscctionneednolMcomPlemJ Bine pennil i.fnrune bemired dollars(b11X11 GRI!ASETRA' Z nr Ices.) 1'LANC I.' 'Gln I ccnify that in the gcrfonnunca cal lhu wertA fm which this pa miGx ixnunl,lsh°Il SEWER-SA I AR -S'D oDd IiA.2IN1 Irl'. nI employ any fenum in any Town, I stn hccnme sabjes'1. he Worsens Compen- I:NI:R Y Z Aaiun ws anof Cnlilitmia.Dale WATERf1EAl T IINTAiI.I!CIR ORA I PEIi Applicant + Z N NOTICE TO APITICAN'to:If,slier making this Certificate of Gxempun..you should WAI'1!R SYS]8M/I'BEATING S 1 iP heenma nubjmt m the Wake,is Con 1pereition provisions of the Lary Calc,you muss W forhwilh I..nch lPly with son Dov t' , ha,el'nlil shall he dalnaIII m,,A d. SITRViCB W r PAID CONSTRUCTION LENDING AGITNCY NE NILSIDIiNT1A1.I'LM1IB. SQ.PI. Dae R¢eiPlx UQIharehyalfin,hat there lxa Omswclinu landing agency tot l heperlmnnanec of F' the work for which lois retail is issued(Set.3097.Civ.C.) '1'01' 1 O U Lemder's Name TOTAL: r Lcndcl'%Address BUILDING ITT .► 0. I canny that 1 have read this application and Stam that the above information es .F.I (n correct.I agree nt comply with all city and county ordinances and%raw laws nelain"a Ql'Y. MECHANICAL PERMIT FEE SEISMIC FF.' its U haild......11grudion.; Ih"'byatal rimmpmsentylvos of mlxciry In coW.East the aMtve-mcmioncJ propary for inspection garpencs. PERMIT ISSUANCE: 1R.FCIRIC 71 (We)agree I,save,indemnify and keep h males.the City of Cuieniao against 1 linhilldas,j+IJglne.'nlx.too's unit csPcnsos xiorh may many way ncOcngainsl said Chy ACI'Ilk OR ADDT0 to PLUMBI ' APLICaenfe of the granting SIsisp WILL AI'I'hICAN'I'UNDERSTANDS AND N'ILI.C(IMPLY WI"III AL1,NON-POINT AIR HANDhING UNI'1'lTO IILUIM CFMI MI!CHA '1 SOURCE;IG!CUI,A'IIONS. AIN HANDLING UNIT(OVITIi If1,I11Nt CIT!) CONS"1 lO, 'rA% I It S ,ia.mol Appftc:11y Ivtrumor Datc EXI IAUST HOOD OVIDUC) HOU. GMITI A'r10N ITE AY,ARDOUS MAI'ERIAI.S DISCLOSURI; Niel the applicant or future Molding accupunt store or handle hmanln Ornot l HGATING LINE r(TO 10f00E BTU) ux dufmM by Ilse Caren lnu Municipal Calc,Chapmr 1).12,and the Health and Salo, If maxi INC,UNIT(OVI!R 10(tan)It I'l1) Cede.Seen I255121ay, ❑Yes 0 N VGM'[LAI'[ON FAN(SIb iRESIDE ('AID Date Receipt a AS Will I Ic aPplicam nr future building occupan use equipment or devices which BOILER-COMP(3111'OR IIXI.(NX)RI U) .,it hazardous air contaminants a%defined by the Bay Arca Air Quality Management 'I OTA h: Dented'! BAILER-CUMP(IIVER 10fir X1IGID L]Ycs F-1 No AIR CONDI'DONER ISSUANCE UATF; have read the mode,S,m...1, 55 5,255'3.1 ancut,muter Chapter rsta of the Cali- Icmin hIIvIIh hSu6ty Cede,Scdiunx 255115,25591 and 25534.I understand Ihul ihh° N1CW Rli$IUITNTIAI,MI!CII. SQ.PI'. nuilJing Jexe urn eurremly haveamnanl.ma it is ley msplmzibilitymnotify the aTupenl e � ohne ra':ptir teals wM1icn mux'rte mol pnunuieluance n(a Ceniticulmd(k'cupunc. Owncrurautbonic -ni 1 e 'I'DE'AL: ISSUED BY: OFFICE 11 } f vA 'All ADDITIONAL PERMIT FEES -7 a -;k"\ .� I e BU I LOINS PROJECT IDENTIFICATION VALUATION RUi OINC, ADORESS /. OWNERS S NAIVE FEE SUMMARY CD MTRACTOR s NAE BUILDING uC.NO. PLAN CHECK CONTRACTOR 5 FEE ADDRESS PRONE SEISMIC FEE OTV. ELECTRIC PERMIT FEE UTLETS-SWITCHES-RECEP ELECTRIC LIGHTING FIXTURES PLUMBING PPLIANCES-RESIDENTIAL PANELS 'jam MECHANICAL SIGNS SIGNS TRANS. TOTA Z ZO SPECIAL CIRCUIT EMP.METER OR POLE INS. PERIVIT VALIDATION MOTORS SEE FEE SCH, 0 SERVICE CHANGE Z Z J t F 0 TOTAL � ' • = y ISSUANCE DATE UJ > QTY. PLUMBING PERMIT FEE BE EEECT. 6MECH. CL 0 Z) 2 ALTER-DRAIN&VENT-WATER(EA.) U O _ BACK FLOW PROTECT.DEVICE 0 w } ti R,ROOF,AR EA,COND. FIXTURES-PER TRAP z GAS-EA.SYSTEM-11NC.40UTLETS INDUST�� •~ _� ,, ,_ LAWNSR AL SPRINKLERS INTER. LAWN SPRIN KLERS1INC 5 V.B. . �. LAWN SPRINKLERS-OVER 5(EA.) SEWER-SANITARY-STORM EA.200H/ WATER HEATER W/VENT WATER SYSTEM WATER TREATING EQUIP. TOTAL 2p J�4/`10 QTY. MECHANICAL PERMIT FEE ALTER OR ADD TO MECH. ` APPLIANCE d AIR HANDLING UNIT(TO 10,000C.F.M.) `y •� • I 1 AIR HANDLING UNIT(OVER 10000C.F.M.) EXHAUST HOOD(WITH DUCT) HEATING UNIT(TO 100.000 B.T.U.) HEATING UNIT(OVER 100,000B.T.U.) •l'I"�'� _- N 1 "I VENTILATION FAN(SINGLE) BOILER-DOW(3 H.P.Or 100,000 B.T.U.) •I BOILER COMP 10.++TOO ODO BTuI SEE PEE SCR. �\ � • , - TOTAL /i