S 2488 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CPPV OV CUIaERTINO BUILDING-ELECI'RICA]. PERMITNO.
nuILU1NG DI VISION APPLICATION/PERMIT PLUM NG-MECUANICA. (ry 2488 A 4 O O O O
BUILDING PRoJEcr mucin IFIcxTION O G
BUIIAINGADDRESS: SANITARY NO. APPLICATION SUBMI19'AL DA3'Ii
S O T v i (2d 2-s-y9
OWNER'S N li: PHOJN T CD 'I'ItAC'I'OR S NAME: / IIC NO:
® / 3 Z /G/I fC,,- {/ ru1 N/C CONT/IOL'#
�ARCIIITECr/ENGINEER: LIC NO:` AI >H J:s/ 2 Com. r�G✓T c✓11 °
C NT9CT, f2 I n S-p 24 70-O61> BUILDING PERMff INFO
5�.tp I` YI'17 '7 /U ❑ Consultant Fees Paid byApplicant(Initial) BLDG [1L'I'iICI'�PLUMB MI-E-CIIi/
❑ 6�' ❑ D
LIn 0.1 1D CUecaled TOR'S DECLARATION Q'FY ELEC'I'k C PERMIT FEE
1 hereby 7000)of
mat 1 at NheBr under rade ar,,of Chapin, i 0.'.mmenang JOB DESCRIPTION
D0Z with Senion](NXgof Division3ofine Business and Pndcesinn1Cole.and my licenwie L,
til w P I'F.RMI"f ISSUANCE SFDWI. ❑KITCHEN REMODEL
Fm� ml'tdl rn�ttmlen��� T^ /
�UU DacltseC j.�—lisp gpPL1ANCE5-RES'IDPNTIAI. ❑ADDITION ❑PLUMBING Ii III'IPI:
�,Ua nate �—i—cnnlrartm —
ARCHrrECTS DECLARKI'10 ❑MULTI UNIT ❑STRUCTURAL
F�N PANELS
Z O z I understand my plans shall M used as public records MODIFICATION
GP'1'0200AMPS
OZ- ❑INTF.RIUk El CHIMNEY REPAIRF-4FW [Jermed Professional 201-1000AMPS IMPROVEMENT ❑SWIMMING POOLS
KY�j OWNGR-BUILDER DECLARATION OVER Inch AMPS ❑HATH RE•MODEUREPAIR DEMOLITION
0 K Q L hereby affirm that I am exempt from the Contractor's License Law for the
O y U following ue,i, .(Section 70315,Business and Professions Codd,Any oily or county SIGNS ELECTRICAL ❑OTHER
3 WN whEb require'a permit at crmsarea.aIle,improv..demolish,or mpair any smaure
FSO priomo it,leeuanee,also requires the applicant for .in permit to fila a shared.a:tente, SPECIA I.CIRCUIT/MISC.
R, that he is licensed pursuant to the provisions of the Contractors License Law iChapar 9
p�t0p m.nonuncing win Section 7000)of Division Sof me 11 a,,.c,s and P c,,i.m Cale)nr TEMP,MEIP.R OR POLE INS'II COMMERCIAL:
d e C the,Im is exempt looter nand the moi,for the ullugesl emer,sio i Any Anhown of ❑NEW BLDG/ADDI'I[ON ❑DEMOLITION
+ may
Section 7031.5 by any applicant for a permit subjects the applicant loo civil penalty of POWER DEVICES 1-1 TENANT ❑FOODSERVICE
F-Z
not more than five hundred dollars(ES(Ap.Y IMPROVEMENT
[,as owner aflhe propeuct or myemployeeswith wagesrsaleinole 0,14,Bsines, SWIMMING I'OOLIiLECIRIC
WQ❑ will do f1,,i its usede IIn,Corr iionot i mended Lovee dor,im,
, ,fly ]i evaslness ❑O'fHIiR
H
6'3 m and Property
who
GtJc The wa,diamm I:Iad w Law ;enc nm apply m un awncr of OUfLIi'I$-SWITCIII?S-FIX'1'IJRIS
papery who builds or t s tl such rand who Awa such work dmwlf f red for
his own however,
employees,ralinprovided that such improvements ate not intended or offered for NEW HESIUIiNTIAI.IiLECfR fT.
sale.If,however.the building nrimpnrvemem is sold within one year n(cnmpldinn,the SQ.FT.FLIX)R AREA SI$Q.PT
owner-toriklei will have the burden of proving me,he did not build or improve EnrPrF
Pose of sale.).
Fl 1.m owner of the progeny,a esdusively commcting with licensed contractors to 'rtTfAL:
construct the project(Sec.70cD.Business and Professions Codl Contractor's Li- .
txe law dos nm apply wan nwnmorproltcrtr who hulld nr llnpmvea 0tcrnnn,and QTY. PLUMBING PERMIT Ff?E
wh xualmem InrsucbpJetts with aeanmactor(s)licensed p.rsutnt ml be C...no,ors
License law. PERM I I'ISSUANCE
I am-exempt under See. ,B&P C for this nation
Owner Duln ALTER-DRAIN&VENT-WATER(EA) VALUATION
WORKERS COMPENSATION D fiallowinN PACK PLOW PI2OI'EC'I'.DEVICE //0O 0 U
441 I herby affirm under penalty of perjury one of the followingWarkees Ce
❑l have and movidelntar by oCcrihcamof Ce Labor Code,Immfia Workers Compere- DRAINS-FLOOR.ROOF,AREA.COAD, STORIES '1'YPECONS'THUCTION
-s:minn ¢s pmvi the for io Ss issued.
3]INLI the fahm Code,fur the pednnnuncm of the
r which this penult is ensued. I'IX'fllli ES-PER'I'l1Al' Q
have and will mammon Went Compensmion Inomence,an required by Section
t]00ofthe lavarCMe,for the performance of the pork Buwhich this permit its issued. GAS-IiA.SYSTEM-)INC.a OUTLETS OC'.GROUT' AI'N
CI orkr�v Cf pen-dIi kk orris and Poftcy Nu�numeft n
C_ RK Ll. pVV I s D GAS-IiA.SYSTEM"OVF.Ri(IiA) ,�
CERTIFICATE Op EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GRri S1%INUUSTRI.WASTE INTIIRCEI'IDN
IS NG 'T(IN FEiiS
GBis section need not bmmplaeA if the permit is for one hunJnddollan($100) GRIiASii TRAP
nr
less) I'LANCHECK FEE
loonify l hl in the Petlinumasalthe wrk far which th'm perm,is eaual.I shall SEWER-SANITARY-STORM EA 200 FI'.
not employ any Person in any manner m as to became sabjem to the Worker'Compen- i ERGY P'I�
Z s.I.n laws of Cliental Dine WATER HEATER W/VBNT/ELIiCTR
O APPlicarb
NOI'ICETO APPIJCAN'I11I;abc,,uoGr,this Cmifcacof Eimmption,you should WATER SYSTFMGEPA]'INC,
F bee.me whim in the Worker',Contpensmion provisions of the labor Gude,you must SOIL S FI➢i
Wforthwith comply with such previsions or this paraiLshall b deemed revoker. WATER SERVICE
0. Q
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL I'LMB. SQ.Fr. PAID
"7 Z Thereby off ret mal Chore iso cunmrumion lending agency lbrlhe perfunnanoenf Om Recaiptp
L) - Eve .,k for which this vennil its issued(See3097.Civ.C.)
{S. E'•' Lenders Nana TOTAL:
L) Lenders Address 'DOTAL: _
I cruily tor,1 have read Els applmation and.a:te that the ahove information is BUILDING FEE
h correct.I agree m comply with all city and c.only ordinances and sola laws relating to QTY. MECHANICAL PERMIT PER
V Z building comarueties.and hereby authorize mpresenmtivcs r iscity Wennr nPari he SEISMIC FHH
abuse-mentioned progeny far inspection purprws PERMI'I'ISSUANCIiA(�
(We)agree tonave,Indemnily and keep hwtnlcas the City of Cap
eran again' ELECTRIC[;[;I.
I'abilities.jndgn¢nt..coon and expand whitlt may In tory wry uccl'uc agninN snlA City ACI'IIRORADD'I OMECIL
consequencein afore granting of this permit. PLUMBING ItiE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.000 CFM)
SOURCE 1:61A ATJQN ^/�/55 MBCHANICI ON T y 7r
SS{{//// ((����� AIR HANDLING IINI'1(OVER 141 0 CPM) CONS'TItUC'fl(1N TAX
Signamm of Apphcant/Ci ream, I jDan, P.XHAST HODD(W/DUC11 I HOUSING MI'HGATION PEE
HAZARDOUS MXITR1A1S DISCLOSURE
Will the applianta future buildia,,ampam erns.,handle baznrlousnmtenal HEATING UNIT C0100,00[1'1'(D Z,
as defined by the Cupeimm Munlcipul Cale,Chmpar 9.12,mad,ha Health and Saidy
Code,Sodom 25532(a)? �-I�(/ HEATING UNIT(OVER 100.000 BT1J)
Yes Y
VENTILATION FAN(SINGLE BE PAID Dole
Receipt N
Will the mpplicanl or Faure building occupant ass ago,n m,to Jeviccs which
emit hazalloms air comamimana as Jefmal by the Bay Area Air Quality Management BOHLlilt-COMP(311P OR 100,08)BTU) 'HYI'AL: ,
District'
2,2
❑Yes BOILER-COMP(OVER I Wits)BTU)
No
I have read the hamrder,nta,fit, quire e,made,Chuucr,6.95 at l he Call- AIR CON Di rION ITR ISSUANCE.DATE
fitmia Heahh&Safery GsJc.Sectinns 255.5.25533 and 25514 I undemanJ thin if be NEW kISIUF.NT1Al.MF.CH. SQ.UT. �
building docs not currently have a tenant,that it is my msponsihility to notify the(werpann —0 AIvs7,0 .✓Cc,'
of thegequirpytrnm air
py¢�t/�et prirnmissuow,of a Cenilicamof0�� cyl
Owner meuthoneed agent _L// )m� 'TO'T'AL:Y 7 70 ISSUED BY:
OFFICE