S 2016 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CI.1-Y OF CUPER•1-IN0 BUII.uwC-HLECTRICAI, PE811 NO. 2016
BUILDING DIVISION APPLICATIONIPERMIT rLU.NIHING—MECHANICAL k\.1
HUILDIN'C PROJECT IDF.NA IFICAI'ION'
BUILDING ADDRESS'. SANITARY NO. APPLICATION SUHMIITALDDATE
Z402_70 e r-1 F-eyejSbp1w�
IIN'N N'S NAME
�tAe �'1 �� V(�N(J6 L C eNT CC. eL11 1, ,�(204'Z
7 NIC nCI1/N'1'k)Lp
NCHI'f1iCT111 GINHHR: �6/V LIC N11 ADDRESS: ❑ J( `/ /
� c - 06 J 1 (r,
CONTACT: DONE BUILDING PERMITINFO
�to) ❑ COnsultealFccsPaidbyApplicent(Initial) HIDDGI IiLF.T/ PLUMB
MECH
Q Wo �OON —.•� /� O Ll L� N? ❑
LICENSED C'ON'I RACIOR:S DECLARATION Q'pY. ELECTRIC PERMIT FEE
I nosy ufanu mal la licensed ander p....imn of Chapter v(commencing JOB DISC{JIPTIO(J�
�aO zO wiTh Scctinn](XXp of Divir.innlur Nelluaincvv end_I'mlcvni�m,VC`dc.nnJ myliccnw ie PER MI'1'ISSIIANCI? RESIDP,NTIAL: ReP q� IKCI W
F+�� atoll lincc and cffcn. 7 `oD ❑$NOWT. ❑K IICHEN kI�ODEL
aU Liacnvc Class Laced APPLIANCES-RISIDEN'1'1A], ❑ADDITION El PLUMBING RE-PIPE
F me Cummnnr
y p, ❑MULTI-UNIT E:1 STRUCTURAL
y ARCIII'IF.CTS DECLAR TION PANIi1S
F MODIFICATION
Zp�Z ndcntndmy plans xM1all he.snit as public,co-nds UI'T02W AMPS
OZ-0 IM"fiH1pR ❑CHIMNEY REPAIR
F�f til Licensed Pmfc,,marl n2ffl-I�AMPS IMPROVEMENT SWIMMING POOLS
.J OWNER"BUILDER DECLARN'ION
AMPS ❑BATH RIiMGD1iI/REPAIR DIiNOLIT ON
WI hrash,(lion on 11. uempl from me Canuacmrx License Low for the iC Rd ll�lluwi9g n ,.(Section 91111$,Ihlstnce unit Pndca s Gnk:Any city or county ❑OflIliwhich tcyui cs a period m canprael,a ne,citnpn,vc.Jct alivh, ,sou,any.tonsure )0Jpr , T L 4 :d 'ipl f p I .6dandancat RCUIT/MShath edp tI th p n: fth C I I' Le (ChapterYCOMMFRCIAI %II O��{Y�O (conioncrcng with Section]00)ofDvion 3 of the Burnes.andl (.: CMe)or R OR POIC INS'1'.
W d C That he is exempt mc.efunn and The basis for the alleged exemption.Any violation of ❑NEW BLDWADOITION ❑DEMOLITION (h
x�a Section 7031.5 by any applicant far a permit subjects the applicant to a civil Penalty of POWER DEVICES
FZ} monad than Five hundred dollars(55B)L ❑TENANT ❑FOOU SERVICE Ih
=Q LasownendlM1c n.nnn to cc with wh ks us meirmle rota tion. SWIMMING POOL ELECTRIC IMIII:R fF:NT ,Cry
EFOpr"M c Yot Y 6 tensa ❑OTHIik J
_ sv 111 the k JIM1 structure nlintended 11 Jf sale(Sec.](H4tl -i ns 3
Lam WI 1 C I II C I' n :1 1 J . t pplYI of A-WETS SWI'ICIIFS VIXI'URF_S J
phopell,Who M1 l ,or nourovel,hicrein, J holloc,%hahR hinnodior ffirao,h
hi,ovonnpinyees,provided thin aueh tap emenx he on obadRd roflerod finNI;W RES1DLNI Al,LLE C'I'R SQ PI'.
nal,.It.invest,the buuding a.Lnpmvemcnti �o1d wlThin Enc yrmhDdmplctmn the SQ.lets FLOUR AREA $ISQPT.
.
nwne,"hwlder will have the harder a(proving that he did hill build ar improve fit,par- /(
Enc of wwn). TAL; L+1
a 1,,f owner of he pmpeny,.,it exduzively comrachng with licensed rommnnn to Q
,mmact the project(Sea 70W.Business and Professions Cadc:)Me Control I i
cense Law does not apply it,an ow neral proper who build,,to improve,mcreon.and QTY. PI,UMHING PERMIT FEE
who ennuam for such project%with o camrd hood licensed punvurn m the Contractor's
License Law, I'IiRMITISSU NCI:
incn ez mpt trade,Seo. ,II&P C for m,s reason
01"r DoneAhI'uk-DR N i?N'I'-WATHk(EA) VALIIA'IION
WORKER'S COMPENSATION DIICLARMION 13ACK FLOW ( :LDL CEI I � OO�
. I helemy alBro,under lenally df,caphy one of the fnHnwin,Jeelar tiom: 1
❑I have and will maintain aCenifcatcof Cansenuoselbinsone for Worker's Compcm DRAINS-F1OOR.RO r .A. D. STORIES 'I'YI'Ii CONSTRUCTION
ration.us pms;ded for by Section 3]110 of the 1,Amr Gavle,for the peRarmance of me
work for which this pemut is issued. FIXTURES-PIERT .
❑1 have and will nmintain Workers Compensation Inwmnce,a,,hapored by Smian
3]IXloffle Labor Cade,forme performance ofthe work lis which mix permit is i,sued. GAS-EA.SYSTEM-1 INC. OCC.GROUP AYN
My Wilda,Compctesllan Insvamce leaner and Fwicym n'
•yl Cxrriar: Policy No.: GAS-IIA.SVS'fllMdlVl!R4(IiA)
(/\1 CFkl'11lCAEIi(d7EXE PliONFROMA KKERS' ORIIASFJINDUS'IRI,WASTIi IN'II;RCEPIUk
COMPENSATION INSIJRANC17 BUILDING DIVISION FEES
(no"ciionnecd nm hecompletedA mepchna is limmc hundrrAdollan(SAND GREASETRAP Y�
nr less,) PLANCIIIiC13D
Icmify mat in the pcdi,mantt of the wod(orwhicM1 this pcnnit irissucJ.l zhall SIinoa. SANITARY-STf]RM EA.21X1 Ff.
nalemployany,twoluanymanners `nccnmesubjecth,theW rs Compen- ENEHGI'P S^C11
,Z sm 1 fC 1 f,rye. 't t WAT12R HFATFR WNEM'?LECTR GRAD FI
Appl I (A'
NOTICE TO APP ANI II k gln'C I( t•a1 .xen,puon,you sh mlJ WAIF,R SYS'I I:M/fHliAl'ING
Nff SOI S 'TI:
F ec
"Oh?. I 4h W k ,CC ,sc I & " : f The Labor Code,you oust
I'onhwlh team with n,ch p...... It...punlnhill adomed mvoktd. WATER SERVICE
CONS'1'RUM ION LENDING AGENCY NEW kLSIDIiN"1'IA1,I'LA111, SQ.FI'. Dam Re,cip,M
S
UQ Ibeach,affirt there is.conslmction lending agency(,,,,he pe,Wmnanceai
the work for which this permit is Issued(Sec.3097.Civ.C.) 'I OPAL:
�' F•' Knit,',Name
U Lender's Address A1;
} W a. 1 ecnify that 1 have lead this it,ladfioh and ome that the,Nice information is H ILDIN(i FEEV
F,, c(mecl.l agree to comply with all city and coumy ordimareeand.tam laws relading to QTY. MECHANICAL PERMIT FEE SIEg IC F[E
U boiling clmtmedan,and hereby anmaeverepmcmodvesatmie dtym elder upa.lme
imus ncnuoned proper fon inspection Pnrynse PERMIT ISSUANCE W
b
of We)ngme to sued,iudenom y cod keep nounic,the City of Caperll,la again..
lienipdns,jud'unm•cnv1,and repersds which miry in any w hyac,mr agaiameaiJ City ATT ER OR ADD TO MI2C11.in consequence of IM granting of Tl,is permll.APPLICANT UNDI:RSTA N DS A ND WILL COMPLY WI'I I I ALL NON-POINT' AIR HANDLING UNIT LTO I IIJXXI CFM)SOURCE REGULA'I IONS. AIR HANDLING UNI I'(OVER 10."CFM)Slgnmme ofAppEieam/Cantccmr Date EXHAUST How(W/DUCE)
HAZARDOUS MATERIALS DISCLOSURE
WJl the opplh-amar lmale building occupant cant,handle hvardouamaterml HEATING UNIT TO HX11XM)RTU)
nr Mined by The Copeman Municipal Cale,CCapar 9.12,uhl the I Iu11M1 and Safety
Cady.Section 25532(u)" `' HEATINGUND(OVER 100JIM11'1'tll
❑Yes ]U Na VIMILAT10N FAN(SINGLE RISID) 1AEO
` Dam Rccc'
• Will the applicant or future building oecupanl au ryuipment or devices which
emit ha erdous air contaminants as defined by me Bay Area Air Quality Management I;OILER-CONY(3111'OR 10C.001)BTU)
District? BOILER-COMP(OVER 100.00d BTU)
El Yes y7 No
I have read the hatmJOnx materials m ms under Chu 6.95 of the Call" AIR CONDITIONER ISSUANCE DATE,
yuircmc pts
lamia Health&Sulmy C'ulc,Sections2 255D:mA 25514.1 understand that the NEWREMBEN'HALMECIE. SQ.i'I'.
huddingdmcol t tarrenlly huvwtsum ,the tl is
myfegmtLsihilitymnmif the tdlu( r�
of the reyaiayne l' I ,mq he carm leeuance nluCenlFicam ( '
Owner or au red ages DateTOTAL-: ISSUED BY: v C • ' I �
OFFICE