99120145APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN
BUILDING DIVISION APPLICATION/PERMIT
ING ADDNLII:
006 - 2-41, (o no
IRISNAME: /I PHI)4ss CONT%J'�ACTOR'SN
soba. �/Olid �iiOM 253+ rJH�I/
CONTACT: ""
�� / � / 4 E3 Consultant Fees laaid by Applicant (Initial)
r'CDIUu. ��L/ N�(. ,s3 -727..
LICENSEUCON'FRACrOR'S DIiCLARAI ION QTY
I hereby affirm thus 1 an licensed under I mvisinns of Chapter 9 (cummencing
with Section 7000) of Division 3 of the Business and Penucssions Code, and my license is
in full force and effete
Licence Class LICC
Date Contras.,
AHCIII'I'ECTS DECLARATION
I and,oland my plum shall he usnl as public mrords
Licenscf Prafcsional
OWNER BUILDER D17CI ARATION
I hereby afRmr that 1 an, exempt from the Contractors License Law for the
following mascot. (Section 703 .5. Bucinas and Profession, Cute: Any city or county
which c,mm, a pertail w coasaam oiler. Improve, deninlinh, ur reluar any structure
pr nn I "n Lo rte, Ih PPI v II :u hpc 1st 11 :'6 dp1l,mut be 1 scJ mend t th P - s(comm g Ih S do 700(b fD fin 3 fan Bu.sthat he a pt th fro1 she b .. h r IM1 II ged a Section 7mLS M1y cony apphcam fora permit svbyus the apPl eons tout vl
boI more than Eve hundred dollars ($51X).
L m owner of the pmpeny, or my employees with wages as heir vele eonspens-a
will Jo the work, and the sanctum is not intended ar offered for salt ISm.7l;4. Burin
and Professions Ccde:'Me Contrat Licen a Law does not apply to an Done
p spcny h builds improves them J h does such k h m: If throng t
his ow pl Y provided flim. h- P ear t t J J rt
le, if h Thebuilding p I IJwithinY' f
bill will has, fl burden tp gInal did th IJ p
1 owner pase as
r of @e properly, em exclusively umvunmg will
heensed c tors n
rol�tma the project (Sec. 7044, Business and Pmfecsions Code:) The Contmer., I Li-
u Law dos not apply to an owner of prolteny who builds or improves thereon, and QTY.
who cormals for such projects xnh a contractual s) licensed puu
muuna mw
e Conetor's
License law.
Iki I am exempt. cr See It& I' C for this reason
ELECTRIC PERMIT FF171
PERMIT ISSUANCE
APPLIANCES — RESIDENTIAL
PANELS
UP TO 2x1 AMPS
OVER 1000AMPS
SIGNS ELECTRICAL
1 hereby affin Juder penalty of perjury one of the following deellani ark
I huvc:md will mainmin a Cen ificme of Concern nt wlf-insure for WarkerxCompen-
xntion, as provided Iia by Semi.... 37(X),,] the Lab.. Code, For the p0 .......... ...I me
work for which this permit is issued.
1 have and will maintain Workers Compematirnt Insurance, as required by Section
3700 of the Lather Code, for the performance of the work for which This permit is issued.
My Worker's Compensation Insurance cancer and Policy number are:
Carrier. Policy Na:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(this suction need nal be completed if me permit is far one hundred dollars (511X)
ar lescJ
1 cenify that in lin any man nee of Ne work forwhichthis permit is icsued.l shall
not employ any pcnun in any manner w as to beatme mbjen to the Workers' Compen-
sation Laws of Col 'forma. Dune
Applicant
NOTICE TO APPLICANT: IL after snaking this Cerilicate of Excntplim, you should
become subject m the Workers Compensation pmvislons of the Labs Code. you must
forthwith mply wins such pmvisions or Thi: Permit shall be deemed re—ked.
CONS"$ RUCTION LENDING AGENCY
I hereby affirm that here is a com moclinn lending agency lin the performance 0
the work for which this penal is issued (Sm. 7097, CA. G)
Lender's Name
Lender, Address
1 cenify that 1 have mad this application and sans that me ohne infarmmian is
correct. I agree m comply xilh all city and county ordinances and slam laws relningm QTY.
building nnnitnclion, bad humby mtlhariec mpmsntnmiveo of this city m emer.pan the
shovemntlioned pntpeny Rn hnpectma purpolss.
(we).gree to save, indemnify and keep h..mdess flue Cityd Cupcnino against
liabilities. judgments, costs and expenses which may in any way ace
...
gainst said City
in consequence of me granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITHLL NON /O 1'
Sf1URCH ��y��GULXfp ONS. / L A
HAZARDOUS MATERIAI S DISCLOSURE
Will me plicaut... future ImAdirt..ant stole or handle hmzrdous material
as deflect by the Cupenino Municipal Gyle, Chapter 9.12, and the Ilnith and Safety
ode, Scctinn 25532(.)'!
❑Yes El No
OuWill the applicant or future building occupant use equipment or devices which
t hazardous air conmmivants as defined by the Bay Arta Air Quality Management
District!
❑Yee F7 No
I hove read me bwanl..u.c mmeriuls rcyuimnam.. under Chopar M195 of the in.
fomia Health k Safety Code. Sections 25505, 25533 and 25 34. 1 undersand that if the
building does n�yJ<urrcnt have a t tathit ie mY ratary fi
a bilt notify me mcv/L
of the ruMiiictRnts wnnst be tt�etnk Pdar ro isufyc r C� nif�y� ortxcuPanip�
PLUMBING PERMIT
P .RMI'1ISSUANCIi
ALTER — DRAIN is V : "—
BACK PLOW 1'R IEV
DRAINS — FLOOR. RODE AR
FIXTURNS — PER TRAP
GAS — IS. SYSTEMIIQC.4
GAS—PA. SYSTEM V
GREASI11NDUS I' RL W `I"
GREASE TRAP
SEWER—SANITARY OR
WXTER I117AI ER W/V
WATER SYSTEMG RRATING
WATER SERVICE
NEW RESIDENTIAL PLMB.
(EAI
OUTLETS
EA. 200 IT
MECHANICAL PERMIT
SQ. ler.
PERMIT ISSUANCE
ALTER OR ADD TO MECH.
AIR HANDLING UNI' 1('1'0 10.000 CFM)
AIR HANDLING ONI'P(OVER I).(X)OClldl
EXHAUST HOOD(W/DUCT)
HEATING UNIT O'O IBQIXX) BTU)
HEATING UNIT(OVI1R Ig1,000 BTU)
VENTILATION FAN (SINGLE RESID)
BOILER —COMP (311P OR I W.001) BTU)
BOILER — COMP (OVER 100.000 BTU)
AIH CONDITIONER
NEW RESIDENU[Al. MECH, SQ. Fr.
OFFICE
C
4BLDGi ELPCI PLUMB M[CFI
JOB DBSCRIPI'ION
RESIDENTIAL
O SFDWL
O KITCHEN REMODEL
27MDITION
[I PLUMBING RF: -PIPE
EIMULH-UNIT
❑STRUCTURAL
MODIFICATION
0INTERIOR
C CHIMN17Y REPAIR
IMPROVEMENT
C) SWIMMING POOLS
O HAI' It REMODEIJREPAIR 0DENIOLD'ION
OOTHER
COMM17RCIAL
❑NEWBLDG/ADDITION ODEMOLITION
❑TENANT OFOODSIIRVICE
IMPROVEMENT
❑OI'Hlilt
SQ.FL FLOOR AREA S/SQ, FT.
707- 3�1
FEE
VALUATION
STORIES TYPE ONSTRUCIMN
2Z
BUILDING DIVISION Ililis
PLANCHECK FEE
ENERGY FEE
GRADING FEE
SOILS Flan
PAID
Date Receipt W
T(ImL:
BUILDING FEE
EF:E SEISMIC FEF.
ELECTRIC FEE
PLUMBING FEE
MECHANICAL FEE
CONS!l RUCTION'TAX
HOUSING MITIGATION ITE
P)Doc HcceiplM
P)
OTIC: