25462 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY
CITY OFCUPER'PINO BULBI O-ELECTRI AI. PERMIT NO.
PINO MECHANICAL
BUILDING DIVISION APPLICATION/PERMIT BUILDING PROJECT IDENTiPICA I'ION 25462 J / 6n
BUILDING ADDRESS: SANITARY NO. APPLICA'nON SUBMITTAL DATE
/0 ild�d�[Lr D2 UNIT# LOT#
OWN I3 'ryAMP,: � � �I•IIONI': C ACTOR'S NA ? LIC NO
IdIH/{/ G`AJ� N/C C'ON9ROL#
All
ARCHITECT/ENGINE' LIC NO: ADDR'SS: AAW1O UI
ONfACI': PITON QTY. ELECTRIC PERMIT EE BUILDING PERMIT INFO
IT PIX' E PLUMB MECII
/TIY(� {� PERMIT ISSUANCE 1:1 11
ICF.NSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB U CRIPI'ION
aZ I hereby affirm that l an licensed underpmvisionsof Chaprer9(e mmencing with
00 Section 7")of Division 3 ofthe Business and Professions Cods,and my license is in PANELS
�usE full force and efTe /9 V/? RK?
/ �7
FZW License Class Lic.# J .7 ] 7� I UPT02MAMPS FI ` 91_ �
ti6y Data Convector 201-1000 AMPS
Z�Dz - ARCHLIECT'S DECLARATION SQ.PI'.FL RARER S/SQ.FT.
1 understand my plans shall be used as public records. OVER 1000 AMPS
oZ_o o 8 38
SIGNS ELECTRICAL}ate--aj hittnweJ Professional
OWNER-BUILDER DECLARATION SPECIAL CIRC111T/MISC.
ALU I herebyn,mo affirm that I am exempt from the Contractors License Law for the
3..[ann which ingreresapSection construct,
Business add pr Professions Care:Any city or county TEMP.METER OR POLE INST.
ON.] which requiresnpermit re mrewct,alaiimprove,h Permits or reform any swmure
� mics issuance,als�rc thea applicant uofileasignedsuaemem POWER DEVICES
prior quires pp Permit
ad
O that he is licensed pursunnuo the provision of the Contractor's License Law(Chapter
,a:00
p9(commencing with Section 70130)of Division 3 of the Business and Professions Code) SWIMMING POOL ELECTRIC V LUATIO f
W�H ended he is exempt therefrom um
and the firms for she alleged exemption.Any violation ofto OUTLETS-SWITCHES-
FIXTURES
V
Section 7031.5 by any applicant for a permit subjects the applicant to a dpenalty of
penaof V
Mnot more than five hundred dollar(5500). NEW RFSIDP,NTIAI.ELECTR S .I'I'.❑ Lasownerofthe property,manyemployees with wages as theirsolewmpensmion, Q STORIES TYPE CONSTRUCT ION
will do he work,and thesvuaure is not intended.coffered hassle(Sec.7044,Business
and Professions Curie:The Contractor's License Law does not apply to an owner of
evommy whobuilds orimpraves themon,and whodmes such work himselforrhmughhis
ownemployees,peovidedthatauch improvemcntsae not inendedoroffered formic.If,
OCC.GROUP RES.UNITS
however,the buildingar impmveman is sold within one yearofcompledon,theowner-
builder .will have the burden of proving that he did not build or improve for purpue of TO
role.). L
❑ I,uowner o(mhepropmy,em exclusively conuncting with licensed contractors to QTY. PLUMBING PERMIT FEE ILOODZANE APN
construct the project(Sec.7044,Business and Professions Commit The Contractors PERMIT ISSUANCE
Lawdoesnm apply toan menerofpfoperty who builds or improves dramemanJ
whin ceutractsforsuch projects with a contractors)licensed pursuant otheContraetors gLTER-DRAINk EA VENT License Low. ( ) FEE SUMMARY
❑ 1 sat exempt under Sec. ,B dt P C for this reason BACK FLOW PROTECT.DEVICE F:.S
SANITARY Y-N
-
Owner Date RECEIPT p
TI
DRAINS-FLOOR,BOOP.AREA,COND.
WORKMAN COMPENSATIONDECLARAON SCIItN)LTA% Y_N
❑Worke
rs'
affirtnothat nhave.
rance nifccaeofcnnxnuendf(Sesum,mr Lm C.))ate ofwhich FIXTURES PER TRAP RECEIPT'#
Workeri Compyee's tnierfluseoracenified copy Hereof(Sec.3800,Isb C.)which PARK FEE Y N
covers all employ«sunder thio permit. GAS-FA.SYSTEM-I INC.4 OUTLETS RECEIPT'p
Pnliuyp BUILDING DIVISION •W
play GAS-EA.SYSTEM-OVER 4(EA) PIANCIIECK ME arias
Certified cap,is hereby famished
❑ edified copy is filed with the city inspection division. GREASE/INDUSTRL WASTEc1NTERC ING
CERTIFICATE OP EXEMPTION FROM WORKERS' GREASETRAP
COMPENSATION INSURANCE
(This section acid not be completed Wine permit is for one hundred dollars(f10(d SEWER-SANITARY-STORM Eak : 1 G
or less.)
I certify thm in the performance of the work for which this permit is issued,l shall WATER HEATER WIVENT/EL[CITt
not employ any person in any manner so u to become subject to the Workers'
Corriscoation lxwsof Cnlifnrnio. Dam WATER SYSTEMiTREATING Date Receipt
0 z Applicant
NOTICE TO APPLICANT:If.after making this Cedificvle of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
FN become subject to the Worker's Compensation Provisions of the Labor Cade,you must
� ; forthwith comply with such Provisions of this permit shall Fre deemed revoked. BUILDING FEE
0. r� CONSTRUCTION LENDING AGENCY SEISMIC FEE t
Uz Ihereby off=that hem is a construction lending agency for the performance of TOTAL: ELECTRIC FEE
O the work for which this permit is issued(So..3097,Civ.CJ
I Leaders Name
O U QTY. MECHANICAL PERMIT FEE PLUMBING PEE
Landers Address
1 certify that 1 have mud Chia application county
sera probe rhe above information is MECHANICAL FEE
r`" w mnrem.dagree
moact comply withalllciryand cmo senminvsofthisciVtore laws
nteru mutual;to PERMIT ISSUANCE
U y move-mentioned
and hcrtbyauctorizerenresenutivn mfthis cirymcmer upamhe
L) z, adwe-mrnmioncd propcnY for inspection purposes. ALTER OR ADD TO MECH. CONSTRUCTIONTAX
(We)agree to save,indemnify and kap henries,in,City of Contain.against
liebilitiu,judgmrnts,cons undexpenmwhich mayimany way.ccme against mid City AIR HANDLING UNIT(TO 10,00)CFM)
Inc miss fife Ing of Ni omit / -
AIR HANDLING UNIT(OVER 10,000 CPM)
ign lore of App icenU r Da EXHAUST IIOOD(W/DUCH
PAID
1A7ARDOUS MATERIALS DISCLOSURE HEATING UNIT('1'O IW,UW BTU) Date Receipt#
Winton applicant or future building.ccupant smut or handle hazardous material HPATING UNIT(OVER 10C."BTU) TOTAL:
as defined by the Consortium Municipal Code,Chapter 9.12,and the Health and Safety
Cade,Section 25512(a)T
❑Yes ❑No VENTILATION PAN(SINGLE RESID)
Will mheapplicanl m alumhuildingcecupare amequipmcm millimeter whicl, in BOILER-COMP OR 100.000 BTU) ISSUANCE DATE
!� hazardous air contaminants.s defined Red by the Bay Area Air Quality Management BOILE -COMP(OVIiR I)(L"BTII) �'i N
DisvicR
❑Yes ❑No NEW RESIDF.NT'IAL MECII. SQ.IT. 17 1993
1 have read the hammous materials requirements under Chapter 6.95 of rhe AUGW3y�7 y
Califnmi.HealthASafety CWe.Sections255o5,M533and255M. Iunderetand mbar 61'Iga a1
if the building does net currently have a court,dam it is my responsibility to notify the 11 Uh With Illy
eepam of the containments which mud be mem prior msum
iace of a Cerdficare of
Occupancy .
Owner or amhariuA.gem Done TOTAL ISSUEDB .
OFFICE