B 0489( APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
"BUILDING
TINO BUILDING-ELECTRICAL. PERMIT N;90489
.fs 0 4 8 9
PLUMBING-MECHANICAL. ;
SION APPLIC O IT BUILDING.PROJECT H)FNHFIC'ATI(. - SOOOI
OAPPLICA'I ION SUIIMITTAL DATE
]'HONE: CONTRAC I OR'S NAME: iCNO: ROC#N/C - CONTItOLNRt LIC O: ADDRESSCOMACT: PHONE: BUILDING PERMIT INFO
6 /J + y)_, ❑ Consultant Fees'Paid by Applicant(Initial) BLDG ELLE-CTT PLUMB MrECCHH
�• i (c.1Y/[_/VI iJ YJ SCJ
.C:NSED Co RACTOR'S DECLARATION QTY, ELECTRIC PERMIT FEE
1 hereby a :rare that 1 am licensed under prosisions o1'Chase,9(eammencin6 JOB DESCRIPTION
oaz msecdan 7axno smn3arthn eusmessa q1 nlmy wvmv's
/ 'u s PERMIT ISSU ANCE
FOO a of farce and CR PDWh ❑KI'1'CHIiN RIiMODEI.
a U u -fee
Class Lic.k
6 U -- iY� APPLIANCES-RI?SIDEN9'IAL ❑ADDITION ❑PLUMBING RE-PIPE
v)"i Q y ❑ale TSCoqDUm
b.Drn RCIiITI!CTS DEC PANELS []MULTI-UNIT ❑STRUCTUkAL
I Z O rns Z 1 underxmnd my m shall Ic uwd as public records MODII71CAl ION
OZ—O UP10200AMPS El INTERIOR ❑CHIMN17Y REPAIR
F�(:; Licemen professional 201.1"AMPS IMPROVEMENT C]SWIMMING POOLS
OWNER-BUILDER DECLARATIONOVER 1000AMPS [D BATH REMODI!llRlil'AI k DEMOLITION
I hemhy affirm thnp
ud 1 um exon (from . ns
the Cmume,..r License Law for the
7°'0aU Whwingreason.(Section 7031S.Business and Pmfessiam Code:Any city or county SIGNS ELECTRICAL ❑OIHEk
YI'3 LL H which requires a permit to construct,alter,improve,demolish,ar repair any structure
prior to its issuance,also requires the applicant foruch permit to file a signed statement SPECIAL CIRCUIT'/MISC.
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9
t ed C. (commencing with Section 7010)or Division 3 of the Business and Professions Code),), TEMP,METER OR POLE INST. COMMERCIAL:
a y a O ythat he is Cxeropt therefrom and the basis far We alleged exemption.Any siation.of ❑NEW BLDG/ADDITION ❑DEMOLITION
iLLC1 I+r Section 703 l S byiny applicant for a perm,s.hjeas the applicant laa,oil pannity of POWER DEVICES ❑THNANT ❑FOOD SERVICE
Xy not more than rive hundred dollars WOOL ' IMPROVEMENT
aa C1 Lasmvnerofin,propeny,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC ❑OTHER
1.. willdo the work.and deswcture is not intended orodertd far sale(See.7044.Business
d 3 m and Professions Cale:The Contractor's License Law does not apply to an owner of OUT'LET'S-SWITCHES-TIXTURES
properly who builds or impnoc,thereon,unit who door such work himself or through
his own employees,provided]that such improvements art not intended or offered for NEW RESIDENTIAL ELEC-fR SQ I-7.
sale.IC however,the building or improvement is sold within one year afcomplction,the SQ.IT.FLOOR ARI?A SISQ.IT.
er-builder,will have the burden of proving Nat he did not build m improve for par- N1 -
[1 1.as ole.l- 3 o G Z
I,as owner of the property,am exclusively contracting with licenses contractors m . TOI'A . _
c ,mid the project(Sce.7004,Business and Professions Code:I The Contradm's Li- - - -
ceaseLawdoesnmapplytonnownerofpropertywhobuildsorimproveslbereon,and QTY, PLUM NG PERMIT FEE I ��� ...///
who contracts for such projects with a contractors)licensed pursuant to the Coomator's )
License haw. PERM]"P ISSUANC (� 7
❑ Iumesemplundcr Sec. ,B&PCfnr Nisuarom
owner Dine ALTER-DRAIN&VE . (F.A) VALUATION
WORKER'S COM PI PerjurI on DECLARATION PACK FLOW PROTECT.DEVI ! 04
Ihandwill affirm
taina penalty of of Comeneof atthe following declaration:,. a
•❑ thaw and will maintain ection 3700 of he Labor
Code
nor Worker's Compen- DRAINS-FLOOk,BOOP.AREA, )ND' STORIES TYPECONSTRUCTION
satins,as which
this
far by Section 3701 of he Labor Code,for the Ierfonnance of IM
work far which this permit is issued. TEXTURES-PEN TRAP
❑1 have and will maintain Workers Compensation Inmranm,as required by Section 11
37w.f the LihrCore,far perfo mace rufthe work far which this perms a isJucd. GAS-IIA.SYS'I'GM-I INC.40UTLETS (KC.GROUT' AIN
My Worker' ,p Toa lnsutw art r and
m arc: '
Currier: A GAS-13A.SYSTEMOVER 4IEA)
T 'O EXIs.MP FROI WORKERS' GREASEfINDU5TR1.WASTE INTERC[I"IUR'
NSURANCE BUILDING DIVISION FELL'
(lhiss cion ne�ed�syt t e d ollars(S1IlU) GREASETRAP
arlean.) M" `�'", ' `,� a ar ' EZ� e
I cenifytha in per4 rman<n(,he kfor huh is n itis issued,l shall SEWER-SANI'T'ARY-STORM EA.2011-7.
not employ any person in any manner so as to become subject to the Workers Compen- F.NIiRG FEE
O z su0on Laws of Cclifornia.Date WATER HEATER WNENT/ELECfR RAUI FEE
Q Applicant
y NOTICE TO APPLICANT:If.after making this Certificate of foo a nner,you should WATER SYSTEM/IRF.ATING
a ' become subject to the Worker's Compensation Previsions of the labor Cale,you must 5011,5 FEE
W forthwith comply wish such provisions or this permh shall N,deemed revoked. WATER SERVICE
d A
UO CONSTRUCTION LENDING AGENCY NI!W ltlSI
! DENI'IA1.]'LMH. SQ.PT. PAID Unte Iteceip(K
I hereby affirm that there is a contraction lending agency for the peromaidee of
e work for which this permit is issued(Sec.3(1 Civ.C.) if
fY th
ULender'.,None TUPAL:
V Wader's Address T'(yIA
I certify thin 1 have read this opplicudon:md trete(hut Nm
Ne base infonatimn is 11 BU] F 6 / 'L. —
tr h corcct.l agree to comply with all city and county ordinances and state laws relating to QTY. MF.CIIANICAL PERMIT •J EE
V Z building conslmctinn,and hereby authodm reprcsenwtivex of this city to enter upon the S 'h FP.
ahnve-mendoned propcny for inspection purposes. PERMIT ISSUANCE(We)agree to save,indemnify and keep harndesx the Coy or Cufertina against m. u PER( a 4 g
liabilities,judgments,costs and expenses which may in any way accme ag•ai nst said City ALTER OR ADD TO MF.CH. PLUM9tNGLEE
in onsequene of the granting of this permit.
APPLICAN' 'NDE RS PAN DS AN I)W ILL COM PLY W I'IIi ALL N N-P INT A I R I IANDLING ON IT(TO 10,00(1 CFM)
MI!CIfA ICALIEE
SOURCE l CATIONS.
AIR HANDLING UNIT GONER 10,000 CFM) 'ITU 'PION TAX
Signmu ApplicanuConlmnur to EXHAUS'EHOOD(W/Dl1CT7 I GMITIGATION IEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building acupanl store or handle harnrdoux material HF.AT'ING UNIT(TO 100,I100B
us defined by the Cuss nina Municipal Cade,Chapter 9.12,and the Health and Safety
Code,Section 25532hu? HEATING UNIT(OVER 10LOK)
0Yes1� VENI'ILA'1'IONFANISINGLL'R PAI --
yyaf,' Dam Reaiptp
Will bLmthe applicant orii ing occupant use equipment or devices which
•emit hamrdous air contaminants as derousl by the Bay Area Air Quality Management BOILER-COMP(3HP OR 1 W, U) / OTAT.
District?
EJ Yes y Nn BOILER-COME(OVER 100.01s)
H U
Ihave Ne baztichsa macrials requirements under Chapter 6.95.1 he Cid- AIR CONDITIONER ISSUANCE DATE
firmaH i Surrey Cale,Sections 25505,25533 and 25534.I and mtand that if Ne NEW RESIDENTIAL.MECH. SQ.Fp.
huilJin ma cmrnntly basso mnnn4 Nat" my resp,nsihilityto tifyl ecu an
orthe quire / is s0lMtt ustbe pr 'ante,of.( c' c ani
Owner or sutharved agent
Date TOTAL' ISSUED BY:
OFFICE
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