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S 2465APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY CITY OF CUPER'FINO - - BUILDING -ELECTRICAL BUILDING DIVISION APPLICATION/PERMIT PLUMBING. MECHANICALS >' BUILDING PROJECT IIIFINTIFICATION " - PERMIT. NO, 2465 HUILDINGADDR ISS: - �) /1 .� Olt V SANITARY IN APPLICATION SUBMITTAL DATE OWNER'S NAME: PHONE LIC CON'IRACI'OR'SNAj. NUC CONTROL# ❑ VI ARCHITECT/ENOINEEIi: LIC N(l: ADDRIISS: �:•�4-1 14s- 0X-jxvx&4/� CONTACT: PHONE: / /� ' /J70 ❑ Consultant Fees Paid by'Applicant (Initial) 't r "BUILDING PERMIT INFO `,1 HLDG ` ELECT PLUMB MECH 171, LICENSED CONTRACTORS DECLARATION nmrkny errs Ton am ucen.ed n,mer pros, ant er rbxpler9 (ea cin nos QTY, (Bj,EC7 RIC'PERMIT FEE _ .�,e rl - P ,JOB DESCRIPTION - �f'r � PLRMI'I'ISSUANCP..' r J wigs i p0B0)ofDiemen 3 ftee fredne,sandP f e„ve d ryTernee', e d Itecl RESIDENTIAL( ❑SFUWL ❑KITCHEN RF:MODCI. AIPIIANCES-RESIDP.NTIAL --/p�n Lic se, Cltq Lich 6•C License RC T'SI Dvm IundcrdunJ my plans IR Contractoras CILAIRAII N 1 QOM ❑ADDITION ❑PLUMBINGREPIPE OMULII UNIT ❑STRLC9 URA[. MOIIIPICATION NTERIOR ❑CHIMNEY REPAIR IMPROVEMHN'I❑SWIMMINGPOOLS BATH RIiMODELIREPAIR ❑DEMDLITIQN OTHER PANELS UPT0200AMPS d' I,icervscl Pane"lonal OWNER-BU?R)ECLARA'HON 1 hcmny affirm Ihnt I ,nth cxenhp Ikom the Comraemr's License Law Lor the fallowing rent... (SacYmn 7031.5, Businc,s and 1'...r .. un, Codon. Any nil, of anal, 201-1000ANIPS -' OVER IItW AMPS SIGNS ELI?CfRICAI, which rcyulr'cs a Fermi, m tvmlmtl, cl a,, Improve, dcmNish, or repair any sdri SPECIALCIRCUI'I/MISC. " ' prior no els iasnan,cal,oreyair:a the applicant forsnen permit u, file aignul smmnmnt ,act hois Incensed Peroaanl to the poor ,ium,rt he Commanr_. License Law(Cham,. 9 @mnmencing with Section 7000)ofDivision 3oThe Business and Professions Code) or TEMP ME I' UR OR POLE INS' I COMMERCIAL: that he is cxmnpt meri and the basis for The aloged exemption. Any vieLi ien of ❑ NEW BLDG/ADDITION ❑ DEMOLITION POWER DEVICES Section 7031.5 nyany epFllcanl for a permit sulljecls the applicant ou civil penally of nor mom Iran five handrral dollars ($500). E]Ens ownendlhe pn,pany, nr my onployce, aim wages ns their sole cnmpenso,ion, ,,It do the work, and the,Inmlare isnot intended orv0ercd Ionone (Sec. 7094, Ranine,, ❑TENANT . [-IFOODSERVICE IMPROVEMENT, ❑ OTHER SWIMMINGPOOLELI3CTRIC and P ofan,inns Code: The Catco s Licen,e Law does sol apply le an owner of OUTLETS -SWITCHES -FIXTURES ' propedy who builds ar improves Ihcrmn, Imd who does such work himselfor through his own employees, provided mal ,rich improvements re not intended of olrmed for sale, If, hmwcvcr, he IS Ida,.,impmvemenl is sold within one year of reinfection, the NEW RESIDENTIAL ELECTR SQ FL, SQ. Fr. FLOOR AREA S/SQ.FT ar- cr-bnllder will have the burden of proving that he did not build or improve for par- ry ' I tch ), pu Itch), ❑ 1, an "I act If preen, an, -1heneely aominrnmg won licensed enowamrs to ,on,cr.elnt p,.ice, (See, 9044B .: ] Plote,lealC.' I I no C 1'1 I , d rPp1Y1-' fp n Iv n b"1d. I .t who conflosdo,he -ehp J I,w"macoa at ... Go lecrivord'oeterainT lConcoetar, QTY'- Ir, PE, UNUTTING tPERMFC. r 1 _IFF PERMIT ISSUANCE I.Iceire Law. EJ I am exempt ander Sec B & P C ha do, mason Owner Dam AUIER- DRAIN & VENT -WATIiR(RAI - VALUATION - - WORKER:SCOMPENSAI'[ON DECLARATION BACK FLAW PRQI'ECT. DEVICE 1 hereby allirm ander penalty of perjury ane of the following declarations: 0 I have and will nmintein a Cerlifncale orGnsent m,ed-inewV for Worker',Compen- ,aline, a, peoidW far by Soalimn 3703 of the Lahor Crate, far me parla'n i nce of the DRAINS- FLOOR, ROOF, AREA, COND.- STORIES TYPECONSTRUCH"N work for which avis permit is i,acd. - FIXTURES -11178 TRAP ❑ 1 baso and will maintain Worker, Corrryemsolmn Imsa.'.. ace, us teeth✓ l by Saabs 3700 oflhe Lab Cr I In IF perfnrnrancenrmc work for wM1ich avis permrl lei ed. GAS - BA. SYSTEM -I INC. 4 OUTLETS OCC. GROUP" APN ' My Worker. •In q� IPnlicy narnbr, �e ,,//�� Carrier:ePolleyNn.. - CAS-BA.SVSTF.Ms)VER4(EA) CERT FICCO, OP COMPENSATION INS PROM WOItI�'BIllS' COMPENSATION INSURANCE CRBASPIINIlI15TRL WASTE INTERCEPTOR BUILDINf3111VIS310N IZII?S [fhin,a:rinn ncW nal hommplctcd ifinepamil ix fonnrehwNml dollars ($lap or he") - - GREASF,'rRAP - - PLANCHECK PEES - Icerod,The,,.ler,r,fannaneeof the walk for' which lhispamil is i,seed, lsball nal employ city person in any manner so es to becunne sahjecntire e Workers' Compen- SEWP.R-SANITARY-STORM EA. 2fN1 PI'. ENERGY PEE WATER HEATER WNENT/ELECTR , ,soon Law, of Calderon. Unto Applicant ) GRADING FEE NOT ICE TO APPLICANT. If. after making This Cemileb , of Ri amprioa, you should bacon subject to the Worker's Corrycn,adon pervasion, at me Labor Code, you need WATER SYS'1'I?M/rEEATING - SOILS FEE ' WATER SERVICE fo0hwithconnPlyw10nsuchprovisionsorthisperneilshallbedecmadmmnk.d. CONSTRUCTION LENDING AGENCY - Ihercby uffinn that mere isuconsmmimn lending ngenry for the perfnnnanceol ,NEW RESIDENTIAL PLMB. - r SQ. FI'. PAID I Receipt IT she —il, bar which this Fcrmil Ix i,sued (See 3097, Co. C.) - LendkrsNmnc 'TOTAL: ` Lender's Addre,s I certify That I have read Ties appeeml me and dam Thal the above of in. i, TOTALI BUILDING F , - .QTY.,' MECHANICAL: PF.RMIT - t R rearlagmcm cvnplywiO,.B,.tyandeotnyon0nm�cesdslaiell�ringto boils stn,to,edn, and hereby,ntlerxo repmsentarves,nn; city (Icmerapnn me ebove-mentioned property for alorl"Fan pnrposc,.I'EIt (Wo) agree to sive, indemnify and keep hennas, be Cn, of C.,amo agni of- liabilhie,,judgments, cads and cxpknnen which may many waysecnmagaindsaid C, ISMICF - MI'f ISSUANCP. ALTER ORADD10 MECH.j l: ' '> PLUMPING FBI A in nN,denceof The gdinfr,ol' avis pumit. APPLICANT UNDERSTAD S AND WILL COMPLY \ I'rH ALL N N -POINT SOURCE REGULATION( /f ^ I 1 AIR HANDLING UNIT(TO 10,000 CFM) r( �' • 1 ANICALP . AIR HANDI.INGUNI'1'(OVER I0000d, CONS 2UCfIO d'AX SignalureofApplicanVCobors, 'Dam HAZARDOI] ATERIALS UISCLQSURP. Will lheappbcom nr rumrc huilAing otenpnnl,lure ur hendla hazardens m:vcriW FI HOOT)(W/DUCT) �) .1IOUSINGMHI RIION FEE - - _ 11HATI_NOUNIT(TO100,O)OBTU) .r��'� o, defined by the Cupenlno Municipal Code, Chapter 9.12, i I The Health and Softy Code, Section 25532(x)? - ❑Yen rNo Will The uppliaml ur fare Threat, mwopaal use cgnipirenl orde,or, which inos as defined by the Bay Area Air Q adily Mari emit hoeardoas sir mnnomm DAbiclI Yes i]f N / n I ❑ HEATING UNIT (OVER 100,000 BTU) PAID - VENTILATION AN (SINGER RGSIII) Dam Receipt IT BOILER - COMP (3HP OR IOO,aNI RTU) TOTAL: - BOILER- COME (OVER 100,000 B U) AIR CONDITIONER I havcread The orowdooneapaluihd_,reym,unIII, under (Battler 6.95 of the Call- ISSUANCE DATE NEW RESIDEN'PIAL MSCIL SQ, EI'. fornia Herith & Safety Cod Sections 25505 25534 and 15534. 1 andeeTa.d flan it the hnk yd t Oyla' 11111' Y p "b10t itm m am - oflh 1" t 1' nu pr'r t ,n,lw nf'IC rIl I�f�nt •. J ISS BY: TOTAL: Ownen,raulhor vent rgk Dale OFFICE