S 3291 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CI.1•Y OF CUPRRTINO - RUILDINC-ELEC'I'IUCAL PEIgIT NO,
BUILDING DIVISION - APPLICATION/PERMIT PLUMBING-MECHANICAL J 3291
BUILDING PROJECT'I DI?MI'INIGCr10N ,
RUILDINGADDRSS: SANITARY NO, APPLICATION SUBMI'T'TAL DAPI
W ER:NAME: PHONH - O"I'HACr R'S NAME: C NU
qR�� II1���FF�A� e s I NIC CONTROL#
lel 'G gWIer 40,ZP�3 " SlJ ar (r . s5 ?vise ❑
HOyE:QdU11,DINC rRMIT INF)`
/ • • - �I�/�9�iij#��
E:1 Consultant Fees Paid by Applicant(Initial) BLDG BLEC'IPLUMB MECH
ram � d d
LICENSED CONTRACTORS DECLARATION ARATION QTY -I'hECTRIC-PLRMI'T- FGF, -
FQoWUZ•V Inreny affinn that am licensed under provichiChapter 9(con nnm r.cm,
JON
DESCRIPTIO' N\
w00 IN fcsiasc deanJmyEc ms PLMII'IlSUANCF RESIDENTIAL
in 1.11e J I / — ❑5'DW. [I KIICII?N
REMODEL
License Class Lic # YEW
APPLIANCES-RESIDENTIAL ❑ADD]'T']ON ❑PLUMBING RE-PIPE
N�6 Dnlc Coellu,lo!
F.DN ARCHIrECTSI)ECLARATION 1'ANEIS ❑MUTAI-UNIT ❑SIRUCIURAL
m Z I nndcrsmnJ my plans#hall he used as puhiic records MODIFICATION
OZ4p UPT02S)AMPS ❑INTERIOR [I CHIMNEY REPAIR
r4 F"W Licensed Professional 201-100K)AMPS IMPROVEMENT'- (]SWIMMING POOLS
^.� ; OWNER-HUILDIiR DECLARATION OVER IODOAMPS - ❑HATH RI?MODHL/REPAIR [I DEMOLITION
Rh ¢ 1 hcmny efine Bun 1 aT cefmpl from the Cnmmmorx Lire¢.c Law liar the
1 IL U following reams.(Section 7031.5,Business and Profession.+Cale:Any city or rnnmty SIGNS IH.ECTRICAL ❑OTHER
31L F which reynims a Isamu in construct,msec improve,detmdim,or repair any smecium
0 prior to itsr also rya .t ppll If hp Iain Ile.,R adxwcncnt SPECIAL CIRCIIITIMISC.
fes} It.,he is Ipurs II dn, '.no: far C t mr 1 1 (Cha,her9
(,)iiivarlain,withScel ]tgo) t Division l m Ils,R 'as i Proe,iim,CuIc)or 'I HMP.M ETER OR POLI?INS'1'. COMMERCIAL:
m M e{>; din he is cscmpl therefrom and to basin for the alleged exemption.Any violation o1' ❑NHW BLDG/ADDITION ❑DEM0LI'110N
-y
Section 7031.5 by any applicant fora Permit subler¢Ne npplicunno ucivil penalty of POWER DEVICGS , 'I?NAM' ❑FOODSERVICE
II store Than fivehanded dollms($5010.
F Z r IA1PR(1VEMI?NT
_� ❑Las nwnennf arc propcny,onny eny9nyees with wagesazthrir sole nnnpensmion, SWIMMING POOL IH.IiCTRIC
will do the work,and the nwttury is nm mmnJed nnnlleroJ for solo(Sec.]lay Rosiness ❑09'HGk
Wm and Pmicssions Code:The Cont 11ar,License Low Jnes:it,,apply m IIB owner of )l]TLI?'IA-: I'fClll?,S-l`IXTGRRS
,rope.y who hold,or improves thereon,and who does.such work himself or Ihnmgh
his can employees,provided that such in, se can;Bre not imendal nr offered for NEW TIAL ELEC?k SQ IT.
sale If,however the huildingor improvutncnl is sNJ within one yeorof catnpillion.the SQ.IT.PLOORAIIEA $ISQ.I-L
ncrbuilder will have tic burden of proving Nat he did n t build or improve hu,sm,
Po f, ).
1 fah pn pctY I . Iy men, th fi,emcd conarprours Io 'I UA4, O
conareads,p I t(See.7044 Ensure, d Pr re cod )*11e Contractors LI-maU �39) �0
L 1 I P,lyI �I' ,uy h 1 I1: , ', ul QTY. IN 'Ih'f Err,;
wOlcrs for suaml e
jnwlh acct mq.Micenseep ant to live Contractors
License I.aw. PIiRMIT ISSUANCE:
01
Q l me cscmpl ander Sea ,B&P C Inc lhhsahunn
Owner Date ALTER-DRAINA,VENT- ATER(EA) VALUATION
WORKER'S COMPENSATION DECLARATION BACKFLOW PROI HC'I'.DEVICE (W OO
I hereby affirm under penalty of Penalty one of the following declamtione �(f
❑ Ihnvcuhdwill hnuinwineCenllirnmal Ce...... ulFinsure cur Worker'sConlprm GRAINS-FI.00R,RDOP,ARRA,CONII.
cation,m provided for by Section 3700 of the Lb Cale for the pedonnanreof he SfONIB5 •1'YI'H UC/I'I'ON CONS'1N�
work for which,h,,permit is ismcd. FIXTURES-PER TRAP
❑ I have and will lnaimain Wmkcr's Cutnpenmlion]it l.nmre hw reynlrul by Swliou
3700of the labor Code,for the Performance of the work for which this fiction is issued. GAS-PA.SYS'I ENI-I INC.40U'1'LIiTS y OCCOROUp AI'N
My Wnrkr' Gm Is nn�lypYangoli_cY nu J 1'�
Cartier:�r C�. TI�ATE(II�XFANI'kOMWORKERS' GAS-PA. 4(LA)
COMPENSAT TON INSIJRANC17 GREAsEr1NDOSTRL WA 'Ik 1
BUILDING DIVISION FEES
fl'bissecdnn need me be completed Pit,prmil is turner hundred dollars 06I0f11 --- --
or less.) GRTRAP LANCIIECK FEE
snlfy that in the Pcrhmnuncc oflho work liar whid,this pennu is isamA.l'hill SEWER-SANI'T'ARY I F.A.2141 FI'.
not employ any person in any mannerso as In tiecnme subject to the Workcrs'Cmuprn- NERGY P1113 r L Q
O ,Z moon Lucas of California.Date WATER DEALER WIVE '.ECT j
z 2 Applicant t AINNGFEE
to N(ITICIi TOAI'1'LICANT:IL after making Nis Cenihcum oft?scmpeon,you shnWn Wn'rCR SYSTI?MO'RRAT
a become e.bjcpi w the Workrr's Compensation......moved do,Lara Code.Yat stmt LS FEE
Iitnhwidt enntpI,with such pnoci or,or this prrmn mull lee dreadn,,Ard. WATER SERVICE
Q
Uz CONSTRUCTION LENDING
r,,erY NEW HT:SIDIiMIAI.PLM! SQ.FT PAID
U O work
hi,h tea mane las rd(Scetinn len dins asency rot me lherrnrmnnce nr me Imreipla
CU I,carr,rnr warn his permR is Laser rser.urn,civ.c.)
O Isnder'n N:une 'fOTq h:
U Lers cmAddress TOT'
F0. Irenify that l have IIB:up,ficaumundoca,thin he choseinfirenalion is SL RUM N- TE
h rnoer,lusrer tnomply 't n ty ul p ar' es Iva In tglo QJYMI?CHANICAh PERMIT ILEd
Uz hungct namcl on and hereh)nmhnrize repmacmmnesufpmcymenmrupap Ne _ SITS 1'P.
unnve-mnuimial pn,N.y for inspection papeses. PERM I'I'ISSUANCE '
(We)til to save,indemnify and keep harmless the Ciy of Ct,mnino agaimt ULI?C'I' IC yiR es
Iiahilities.judgmetus costs and expenses which may many way accrue against said City ALTER OR ADD TO MIiCH.
come(( onrcol'Ihogamingar lhlspennil. 02 PLUF IEEE - e
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT l'1'O I0,00(I CI'M)
SOURCE RF.�UI \TION.. MIiN, CAL FEC
AIR HANDLING UNI'I'(OVER IQOfNI CPM) CONS'TItOL'ON'TAX
namrcof Applicam` u # )me EXHAUST GOOD(WIDUC)
IIAZAR a 1115 MADiRIALS DISCLOSUIt II HOUSING MITI,gTION PIiF.
Will the applicant or utum building occupant store or handle minarets material IIL'ATINO UNIT(TO 100.00 f,BTU)
o Jeff Bed by the Cu"'I nn Municipal Cade,Choler,9.12,end the HUIhh and Socy
Cade,Section 25532(m! BEATING UNIT(OVER I00,0(m B'I'U)
❑Yes 1S7Vo VENTILATION FAN SINGLE RESIDI PAID
T Dmc Ituucipl#
Will the applicant or future building occupam use equipment or devices which
emit haemduus air cm-matinantsas defined by the Hay Area Air Quality Managemem ROLLER-COMP(JHPOR IB(1,M)IITU)
s Di...tO OT
0Yea )(N- HOILEIi-COME(OVER II111,IN10 II'ITj)
"V I have read the hantdousntmer'� ric,dontrntc under Chapter fi95 of the Cali- AIR CONDI'T'IONER ISSUANCEDNFE
fnmia HrnIN&Safe ate,Sceti s 25 U5. 533 and 25534.1 undcrsmnd that if the NEW RESIDI?NDA(.MliCtl, SQ,Fr.
htildingdocs yhove ITh In hay rospnnaibhhtyJll nallfylhcuvupent
oflhercy Im °rrelch muv m N n+is Brenta Ceni(cat r( cup:; A'AL: ISSUED({Y:
( �
Owner ar nuthuri.rd agent - -Dam - `/
OFFICE