99100095 APPLICANT TO FILL IN INFO ATION WITHIN RED LINES-USE BALL POINT PEN ONLY
;RCII
9-C1G.INEFZ.R
BUILDING.ELECTRICAL PE M I'
`�APPLICATION(PERMIT PLUMBING-MECHANICAL, Snn01
SAN if ivr NO. AIPUCAFION SUIIMTITAI.DA'I'I
ERNON110 CT• co re�croa'sN�nu;: C A qS0 LIC No h 6 � t.N/C CONTROL#
R: LIC NU: ADURISS: ❑
COM'ACT. PHONE: BU ILDING PE RM IT INFO _
Ro�Gn�a [�o$ 366 1s3�8• ❑ Consultant Pees PaidM1yAPPlicant(Inifiap NLDC ELECT PLUMBMIRCH
❑ ❑ ❑
LICENSED CONfRACfOR'S DECLARATIONQTY. EIPEE
I hereby ofrm that I am licensed under pnrvisime of chapter 9(commencing JOB DESCRIPTION
^'1aX0 with Section70gpnl DividonSof the nutria,and Profession,Cudc,m,J my licemsci, ItE51nEN"PIAL:
u10I'IiItMIT ISSUANCE
F+Iy in full force and effect ❑SFVWL ❑KITCHIiN ItIi310DE1.
QVU License Class Lie.# APPLIANCES—RFSIDENTIAL OADDITION El PLUMBING RE-PIPE
b-Q W Ome Gmu,cmr
.Oyy ARCHITIiCI"S DECLARATION PANELS ❑MULXTUNI'T ❑STRUCTURAL
Z�~# F I understand my plans shall he used as public records b10DIPICA'I'ION
O'I^G
UP 10 AMPS ❑IN'I FRIOR ❑CHIMNEY REPAIR
f:L4Fyl LicenuJ Professional 201.1000AMPS IMPROVEMIiNT C]SWIMMING PQQLS
Fj OWNER-BUILDER DECLARATION OVER I"AMPS ❑BATH REMODELIREPAIRXDEMOLI"PION
W Q I hereby affair that I am exompt from the C,,mmerois License Law for the
O G V following reason(Section 7031.5,11n.vinco and Professions Code:Any city,,,county SIGNS ELECTRICAL AQ.
DTLIER
B u•1^ which requires a permit to consBun,alter.improve,demolish,or repair any smunure
F"�O prior In its issuance,also requires the applicant for such permit file a signed statement SPECIAL CIRCUIT/M ESC.
W } that he i.s licensed pursuant to the provisions of the Contractors License Ldw(Chapter9
W QQ0 (commencing with Section 7!X ,of Division 3 of the Business and Puresoions Coded TEMP.MEI'ER OR POLF IN, COMMERCIAL:
N W M a that he is onarim interface and the basis for the alleged exemption.Any violation of ❑NIiW BLDG/AIIDLTION ❑DEMOLITION
loci u. Seehnn 7031.5 by any applicant for II permit subicnn rte appfemn m a civil pe'111(,of POWER DEVICES ❑'TENANT ❑FOOD SERVICE
I,-X} nal more than five hundred dollars($500). IMPROVEMENT
=Q ❑ 1,us owner,(the propene urnry employres with wages as their cote rompensmion, SWIMMING I'(I d.ECTRIC
�mwilldothework,and the sweet¢is not intended,,r offered foraale(See.TNA,Bminess ❑OTHER
mol Professions Codc'I he Contractors License Low Jnea not apply m an mvner of OVfLETS—: rCHES—P XNRES
property who builds or improves thereon,and tactics such work himself or(hmnto -
his own employees,provided the such improvements are nut intended or aHereJ lir NEW RESIDENTE 1'R SQ PI'.
side.if.however,the building or impnnxment is sold withinene ycarnrmmpletiun,the SQ.FT.FLOOR AREA $/SQ.FT.
sawma-buidder will have the burden of proving that he did not build or improve for pur-
posa of vale.).
❑ I,as owner of the properly,am esclnsively convicting with licensed ronvncmrs m T(yPAL:
ammo,the Frojem(Sec.7044,Easiness and Pmfessi me,Coi I'hc Cnnnme...s 13- -
cemeLawdoesnotTpplytoanownerofpropenywhobuildsorimprovesthereon,and QTY PI,UMBING PERMIT ITE
who contracts for such projec s with a contmeor(s)licensed pursuant o the Contractor's
License Law. PERMIT ISSUANCE
nm exempt our Sec. .B 5I'C for this newon
-Dolencr In- ALTER—DRAIN&VENT—WA'I'ER(EA) •// VALIJAI']ON
WPENSATION DECLARATION 13ACK FLOW PRO1EC..DEVICE
reby anirnl underpenalty of perjury one of the following declarations: L V
I huveand will nmimmin a Certificutcof Consent,,selfimum for Worker's CmnNr- DRAINS—FLOOR.ROOF,AREA,GOND. STO DiS 'TYPE CONS9'RUCTION
sullen,,0 provided fat by Scedom 3700 of the Labs Code,for the performance of the
work for which Nis permit is issued. FIXTURES—PER TRAP
1 have and will maintain Workers Comns
peation Insurance,as required by Seelion
37M of the labor Code,for the ped'ommnce of the work for which this pennit is issued. GAS—EA.SYSTEM-I INC.4 OUTLETS OCC.GROUP
My Worker's Compensation Imsummce carrier and Policy number am',
Carrier. Policy No,: I GAS—EA.SYS111M-OVER 4 WA)
CHRI'IFICATE OF EXEMPTION FROM WORKERS' ORIiASEIINDUSTRL WASTE INTERCEPIY)R
COMPENSATION INSURANCE 13 UILDING BE VISION FEES
is sevaionneednot beendepkted ermit ifthe pis fora,¢humlred dollars 1511X) GRE?ASETRAP
or less.)(Ibis I'IANCHECK 4TiG
I certify that in theperfnnn:mcunf the work fmwhich thi,termitls issued.l shall SH ]W R—SANITARY—STOIIMFA.21011F1'.
nut employ any person in any manner m m to bermac svA'Iect to the Workers'Ceml en- ENERGY ITE
O Z sation Laws mf California Date WATER PRA ER W/VENT/ELECTR GRAVING FEE
O Applicant %
y NONCE TO APPLICANT:If,after making this Cenificae of Exemption,you should WATER SYSTEMITREATING SOILS FRE Iberian,subject m the Worker's Compensation provisions of the Labor Code,you nest
ferlhwith comply wt.@ ouch provisions o ,his permit shall he deemed revoked. WATER SERVICE
Q
L) z CONSTRUCTION LENDING AGENCY NEW RFSIDENI'IAL PLA1B. SQ,PT. PAID Date Receipt#
.V O khereby which
thatramit iisacomSee.30 lending agency for the performancc of
(~ the work for which thi,p,rmit in isanpl(Sec.7097,Civ.C.)
u" Lenders Some
�1 W Lender's Address '1 OPAL. I LI LNG FBP v
y I certify that 1 have mad this application and sme the me above information is
correct.l agree to comply with all city and county ordinances mdmate laws relatingm QTY, MHO IANICAL PERMIT FI?E
V z building cnnsumcdon.and hereby authndxo representatives of this city m enter upon the _ .'MIC PEG_
neove n,eationed,,rn,efty for ln,pectl,,n puga„na ( 1999
(We)agree In wvc,indemnil' d keep harulcss the City f Cu rtino almost
PERMIT ISSUANCE ;t lil:'f121 Ffils
( g ran p yo m gain.
Iiahilitics.juJgmems,ensu mdupenses which may in unywayacemeugainn said City ALTER OR ADD IO MECIL
in consequence of the granting of this permit. 1'LI111MItING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT TO 10,0100 CFM) NV.6i ANICAL hili
SOURCE ULA'1'IONS
!o �Ir
��gy Ant HANDLING UNIT(OVER 10,000 CFM) CONS'FRUC'OON'IA%
na sof icDate ERHAUST 11001)(W/DUCT) HOUSING MI'I'IGATION FEE
an{AZARDOIJS MATERIALS DISCLOSURE
Will the applicant nr future builue,owuPumtsere or handle faccammmmminl 1117ATING ON IT(TO 100,01X1 It DUE
m.)¢hoed by the Caperdmo Morneipul Code,Ca,o,,912,and the Health and Soucy
Code.Section 25572007 HEATING UNIT(OVER 101,000 BTIJ)
❑Yet E]No VHISTILATION PAN(SINGLE RISID) RAID Dur, Re
l
Will the applicant or future building occupant use equipment or devices which 1101LER—COMP(3HP OR IIX),0X1 BTU)
emit hvardra s air er mmin,m,es dArval by the Be
tiny Are,Air Quality Managemnt L
District? BOILER—COME'(OVER 100,10(1 BTU)
❑Yes [_J No
I have read the hartavers materialsrcquiemen to under Chapter 6,95 of the Cali- AIRCONDITLONER ISSUANCE
forma gdoes& ctimaCtvle,Secllnns25505,a,,ayand25534. to nomamtl that it NEW RP.SIIII?N'I'IALMECfI. SQ.PT. ' �' F+ 7
huilJing Jrxanittnn,mlyhave met
o isuace of a errifim nolifOccupancy, � ( //
of the mems which mus ten prior to issuance ofa Cenificute of Qcuptmcy.
O r mth ed ate TOTAL ISSUED BY:
OFFICE