S 2232 f APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
4, CIT1',(1FCUPFRTINO ,y IUILDING-ELECTRICAL Pfitpf N(1. 2w
BUD.I�.ING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL \v 'LJ
BUILDINGYROJEC1'IDENTIFICATION -
BUILDINGADDRESS, SANITARY NO, APPLICA'T'ION SUBMI'TFAI.LAI
a iac� s ,�,� LIC NO: -z 3- q
(y[ gl�N�J o Pula is O CONTRACrOk:S NAM:.
/\•� L NIC CDNT 3-
CHII'ECTAiNGINI R : I.IC NII: DDRES ❑
lip
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C'ONTAC'T: PHONE: BUILDING PERMIT INFO ,
qac 3 ❑ CinoattantFeaPaid byApplicant(Initial) BLDG ELECT PLUMB MECH
7S o4 El :1 ❑ ❑
LICENSED CONI RACrOR'S DICT RATIGN QTY.',' - fEL1iCTR C PERMIT I FEE
(bereny afrrtnn that licensed J p fah Plm9 anl,t nn g _ e +�•� ' JOB DESCRIPTION
OaZ with Sect an 7lXXpnfD' :ion lofted Bus els anJl cores. Cole,and mylic . RESIDEN'FIAI.:
HOC PERMI1 ISSUANCE
CWp nhll f,ceaml J4u1 Z� SFDWL EI KITCHEN REMODEL
r aU$U Lice Class Fi Or ❑❑
APPLIANCES-RESIDENTIAL. ADD ❑
I'110N PLUMBING RE-PIPE
N Q L I). Conlrncmr
FOw ARC(ITEC'TS DFCLARATIO PANELS ❑MULTI-UNIT ❑STRUCTURAL
ZOy,Z, lundemm�d my plans shallMuseJ as punlience. .a MODIFICATION
OZ4D UP'1021X1 AMPS [DIN'I'ERIOR ❑CHIMNEY REPAIR
l-an1:W I,ictowd Profisoncial 2111-I0bd AMPS IMPROVE ENG PGDLS
OWNER-BUILDER DF.ChAkATION OVER 1000AMPS E]HAI iMOD1iIM711AIR DDENIDLITI
a 1 hereby affirm that I am exempt from he Cnmracom's License Law lis me
O y U B,powing maven.(Nation 711.11.5,Business and I'mfeuiuos Coak:Any any or aou SIGNS ELECTRICAL O E
which mNircx a P-ou In con...a,,,alter.improve,date i4r nr repan may smutur
F X04 prionoia issuanro,also requimsthe epplicunl fur.wcn pcnniuolilcasigned mmemem SPFCIALCIRCUITIMISC.
pipn� thw hal becowdpursmmt In the provisions of the Contrncmr's Lidase Law(Chmptm9
yr00 (commencing with Secllon7fNXgof Division 3 it by Baines<md Prafcvsionn Cndu)or TEMP.METER OR PULE INS'IL G
IL Xe q [wt he in exempt therefrom and the basis for are alleged courr ion.Any violation of ❑NEW BLDG/ADDITION I]DEMOLI'11I ON
WW Senion 703 1s by any.,Nalunl for a permit sunjas the npplinmt to n civil penalty'It ii DEVICES INAN'I' ❑FOOD SERVICE
urn mom man Five hundred dollars(S5W).
E m
IMPROVEMENTREo ❑ I,asowneradmapram¢nr11rmrampIoreeswilhwasesasthcirsolecom nsutor, S MMING POOL ELECTRIC OTHER
moo will do mewmk.lnd dm,wmnrehanded I,,nrerll atam(See.71u4,ua.ine.a
W 3 m ua,l Pn,fe....it Cole:The Contractors License I,aw does mit apply It,art owner of oUTL>f5-swirCHFS-FIX'I URIS
pnq,cny who builds nr umrynves thermos and vele Joav such work himself or Ihrongh
his own employees,provided that such inipmvemcros arc not intended proffered list NEW Rli, DENfIAL HI.ECTk SQ P
sale.If.Lowaur,the hundingnr improvement is ulA w ohiror,ycium,nopletion,the SQ.IT.FLOOR AREA S/SQ.Fry.
owner-builder will have the burden of proving that be did not build or improve for pur-
p,seof"Id.).
n I,as owner of the pmperly,alt exeluslvcly count ating wIIII Iirea+al coo111111111 to 'EOTALI
eomwet the projem(See.7044,Business and P..sessions Code:)The Comratnr's Li-
seLaos det,ad apply to and nwncr.f prnpeny who an lesor imprrnesmenun,art QTY. �PLUMNG PERMIT':• ( 'EEE
who earned,lnr such projects with a lamruemf(s)licensed par mann,,the Cmnmemf, a'
License I.aw. PERMIT ISSUANCE
❑ l
.,it exempt under Sec. .B&P C Ian l his reason
ALTER-DRAIN&NINNY- VAl'ER(EAJ VALUATION
flwncr Date -
WORKER'S COMPENSATION DECLARATION RACK FLOW PR(yfl?Cala.DIA-
1 hereby rMon under penalty of perjury Ona of the following decimation
' I have and will mainwin a CatiRer(Oul Con seat u—It'-Insre ular Worker.,Con.Pcu. DRAINS-FLOOR,ROOF,AREA, (IND. .TORIES TYPE CONSTRUCOON
..tion,as provided for by Sermon 3700of Ina Laba,Coh,,fonbepverfon terac of We
work Ibr which Ibis Permit is issued. FIXTURES-11101 TRAP
M 1 have and will maintain Worker's Compelualion Insurance,as required by Section
3700 of the Labor Code,fur the pertimart,ofthe work for which this Permit in issued. GAS-CA.SYSTEM I INC.4 OUTL06 DEC.GROUP AI;N
My Worked,Comlrensation Insurance con'er snit Pulley number are:
Cartier: Policy No.: GAS-IIA.SYS,EM.OVEN 4(EA)
CCRI'H ICS1 li 017EXEMPTION FROM WORKERS' CIRIiASIJINDUS'I'RI.WASTE1NTIEtCF1'ION
COMpENSAT10N INSURANCE BUILDING DIVISION FEES
(Thio section need nm bcenl ipletal ifthe permit is for one hundred dollars($100) GREASE TRAP
or leis.) PLANCHECK FEE
I cenlfy that in thePcrfu,mnceofthe work m,,vhichthispemtit isismad.Ishall SEWER-SANITARY-STORM EA.200 FT.
not employ Imy Paso..in any mann,,so u,n,budomesabject It the Wurkerv'Cnmlwn- ENERGY ELF.
Z Iifnrnim.Data WWI ER IIIiA'DiR W/VENT/ELECIIt
Z ApplicantGRADING PEC
N(YIIGE TO APP
^ ICAN'1':IG alternating his Ccniticaueel Ilsen,Plinn,you shotld WATER SYSI'RM/fREAI'ING
become subject to the Worker's Cm r,voI tum provisions Labor the Laa Coup,you mcd SOIhs FHE
I d ith comply will such provisiulu or l his pcnnll shall he dammed revoked, WATER SERVICE
Y
CONSTRUCTION LENDING AGENCY NEW RCSIUfiN'IIAI.('LMB. SQ.PI'. PAID
UO l hereby affirm that diem is aeonslmefioa lcndiugagency lmnhc perfnrmunccal tenm ReceiDN
(~ the work for which this panto is issued(Sec.3097,Civ.C.)
LL TOTAL:Lender's Nuunc
U Lenders Address 'I OTA h:
� I cediIylh111 .card app]ediumn andLstate thtth b 1 t ) G iE
(moi) mrul las I ply lh II ly J ty e' LII r li gl QTY.', .MIiCJANICAI.P'".BAIT", ni :1 c RE
Z bwlrl goon:coni n and he ehy ummrirs reprcumal c. f h try mcmer uPon,c
above-mcntio.abl,openy l'or in,putia,,n forp11, - PIIRMI'I'ISSUANCE
(W,,)agree,s.I.indemnify and keep ham,lcss the City of Cupeninn ag.ina MCI 1: I? FEE
landides,judgntems.0.,?X Hud expenses whichunay imeny way aremcegaimtsuid City AIAHRORADUTOMECII. 11
in n,equence of the gaming of this permit. P 1 9N Yl:
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALI.NON-POINT AER HANDLING UNIT(TO IB PM)
SOU RCC REG ULAI'I ONS. - MECRA.IC IiG
AIR HANDLING UNIT(OVER 11 CPM73zW;iiIejCpo AX
Signature of ApplicandCommnnr Dam ' L'XHAUN'I'HOOD(W/DUCT') ^"-�� HOUSING MITIGAI' NFEE
HAZARDOUS MATERIALS DISCLOSURE „r•^
Will the applicant or I'umm building oceupwu slum or handle hnevrdnux umnerial HEATINOUNIT(Tfl 100,001OBTU)
as defined by the Cnpenino Municipal Cole,Chapter 9.122,and the Ileal,and Safety
Code,Self...I 255321m)4 I(EATING UNIT(OVER 100.0110 BTU)
E]Ye., No PAID
VENTILATION FAN(SINGI.0 RESID) Data Rate ted
s Will the a,licam or future huina,mccupam useeyimpabi(nr devices which
eros hamnlnusoir 0,maminanla as defined by the Buy Area Air Quality Management - BOILER-COMPOHPOR (IrOgthaTU)
District'!
El Yes -I No HU1LIi12-C(1MP(OVIiR 11111,1KK)II'IVI
I have read the havandiusnialand,requircmcnls.add,Chaplcrfi95 111'the Cali- AIR CONDI'HONEN ISSUANCE DATE
forma Health&Safety Cedc.Sections 25505,25533 and 255.11.I mulersmnd that if the NEW RESIDENfIAC MI CH. SQ.IT.
building does not currently have a lenam.Iled urs.nyresp„.tsi hi lily mnan ry lhi......nl
ufinerequdatxnu,ankh mustnitrotpriorm,.uuancenfa CeniGclneof( -cuponcy.
UwnmeramnrieeJ.,cut Date 'TOTAL: ISSUED IIY:
OFFICE
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