203089
•
•
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification
Building
PERMIT NO.
20308 :
01 oo TD""ff A UE tNST /6?l . ,
caner. time: Ve
A
CITY OFCUPERTIN6BUILDING DIVISION
APPLICATION I PERMIT
/ U
Contractor's Name: Lic. Na
CATECOMY
CONTROL
BUILDINGE7.F)=1WCAI PLUMBING-MECHAMCAL
Arehltect/Engimer. Lk. No:
QTY ELECTRIC PERMIT - FEE
BUILDING PERMIT INFO
Add..
u u
PERMITISSUANCE
LICENSED 1k..d..d,p DECLARATION
IMrebyion70 that] ivsionseduMerpessand ofCssions9(mmmmc
Ingwithin forceofDivf,Ion3o(the5ueimmandlsmlesslonsCode,and my
Is In fora and dfect.
-
APPLIANCESRESIDENML
�]O DE� ON
-i/�-
PANELS
Lkxo
License C6m Llc# -'
s
Date Contractor
201-1000AMPS
ARCHITECTS DECLARATION
I understand my plans shall be used as public records.
OVER IOW AMPS
SQ. FT. FLOOR AREA
S/SQ. FT.
SIGNSELECTRICAL
Licensed Professional
-
SPECIALCIRCUIT/MTSC
OWNER -BUILDER DECLARATION
I herebyalOrm that l am exempt from the Contractor's License Law fer the
following reason. (Section 7031.5, Business and Profession, Code: Any city or
countywhkh requires a permit to mmtmcL alter, (mpmve, de=lish,orrepair
(/�J
!/�(• `�
TEMP. METER OR POLE INST.
anystmcture pricomitsisnuance, also requirestheappliant fasuch permit to
file a signed statement that he is licensed pursuant to the provlslons of the
POWER DEVICES
,
SWIMMING POOL ELECTRIC
-
Contractor's License Law (Chapter9(mmmencing with Section 7000) of Divi-
tl n3ofthe Butln and ProfmIum Code)orthathebemmptthemfromand
VALUATION
the Iasis for the alleged exemption. Any violation of Section 7011.5 by any
m
applicant fora permit subjecathe applicant to a civil penalty of not ore than
OUTLETSSWITCHESFIXTURES
b O
five hundreddollarsof the property,
❑ I, as owner the property, or my employes with wage as sole
NEW RESIDENTIAL ELECTR SQ.Fr.
STORIES
TYPE CONSTRUCTION
will
compensation, Business wok and ionhe sC de: Th Contractorot or offered for
offered
mie (Sec. 7614, Business and Professions Code: The Contractors Llama Law
-
TOTAL:
doesvmapplytoanawiardpropertywhobuildsorimpr .thereogand
whodoes such work hlmselforthrough hisown employees, provided that such
Improvements are not intended orofferedfor sale. If, however, the building or
OCC.GROUP
RES UNITS
Improvement bsold within oneyearofcompletlon, the owner -builder will have
thLkurden of pmWng that he did oat build or improve for purpose of sale.).
u S as owner of the property, am exclusively contracting with licensed
ombaclma to construct the project (Sec. 7040 Business and Professions Code:
QTY, PLUMBING PERMIT FEE
FLOOD ZONE
APN
PERMIT ISSUANCE el
oL
The Contractors Llceras Law dm not apply to an owner of property who
builds or Improves thereon, and who contracts for such ptojecta with a
c�R(IactorW ec licensed pursuant to the Contractors License Law.
LJ I am exempt under SB & P C for this reason
ALTER -DRAIN & VFM -WATER (FN
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
OUTSIDE FEES
DRAINS -FLOOR. ROOF, AREA, COND.
SANITARY Yi N_
RECEIPT#
Owner Date
WORKMAN COMPENSATION DECLARATION.N�q
❑I hereby affirm that I have • artifiate of consent to self -insure, a a
certificate of Workera'Compemutionlneurance or a certified copy thereof(Sec.
3800, Tab CJ
PER TRAP
SCHOOLTAX Y N
RECEBzT N
CAS EA. SYSTEM -1 INCA OUTLETS
PARKFEE Y N-
RECEB'TM
PT
cc pNany
CAS FA. SYSITM-OVER4(FA)
BUILDINGVISION FEES
I miCo
fled copy is heed with thecity
ertlfied copy V (Ikd with the city Inspection division.
GREASE/INDUSTRL WASTE INTERCEPTOR
PLANCHECKFEE
GREASETRM
CERTIFICATE OF EXEMPTION FROM WOR KERS'
PAID
ggWFR-SANITARY-STORM EA 200FT
COMPENSATION INSURANCE
(Thlssection need notbecompieted if the pemdt la fa one hundred dollars
($100)orlm.)
I mr ifythat In the performanceof thework forwhlch this permit Is issued,
Date_ RI!Cel t#
WATER HEATER W/VENT/ELFOTR
ENERGY FEE Y_ N_
WATER SYSIT IA/TREATING
I shall not employ any person In any manner so as to become subject to the
Workers'Compensation Lawsof Califonb. Date
PAID
�t�a
NEW RESIDENTIAL PLMB. - M4P
9
Applicant
NOTICE TO APPLICANT: Ifter making this Certificate of Exemption, you
L a
should become anbject to the Workers' Compensation proWslom of the Labor
Date Recei t#
TOTAL:
'BUILDING
Code, you must forthwith comply with such provlslore orthis permit sball be_
droned revoked.
CONSTRUCTION LENDING AGENCY
t 3.�, i ly
SEISMIC FEE
lhembyafBrm that there is a construction lending agency forthe perform-
anti of the work for which this permit is Issued (Sm. 3097, Civ. C.)
Lender', Name
Lenders Add nm
I mrtlfythat] have read thisapplfathm.nd statelhettheabove Information
is correct.I agree to complyw(th all city and county ordinances and Asia laws
�ornt:
a TPTII
LECTRIC FEE
QTY. '. MECHANICACPERMI FEE
PLUMBING FEE
MECHANICAL FEE
.
PERMIT ISSUANCE
FEES PAID:
relating to building construction, and hereby authorize representatives of this
city to enter upon the above. mentioned property for ispetion purposes.
Indemnify andkeepharmless the Cu pectins,
(We)agree to savejudgments, wayamue
against pdgmenacoA
,saM expenses which in any may in anyy
ALTER OR ADD TO MECH.
Date Recei t#
AIR HANDLING UNIT 10,000 CFM)
SUBTOTAL:
� a7
ago Wt mi ty.ryf'uas ma rat g of this rmy.�
v
Sigratureof AppBant/Contractor Mate
AIR HANDLING UNIT (OVER 10,000CFM7
CONSTRUCTION TAX
EXHAUST HOOD(W/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUS MATdQLSDISCLOSURE
Willtheapplicantorfumre building occupant store or handle hazardous
-
HEATING UMT(M 100,000 BTU)
Date Recei t#
material as defined by the Cupert(w Municipal Code, Chapter 9.1$ and the
Health and Safety Code Section 25532(a)7
nnYea No
1'lll the applica utum building occupant use equipment or devices
HEATING UNIT (OVER I W,000 BTU) '
TOTAL:
VENTILATION FAN (SINGLE RESID)
ISSEiA{`I�>DATE
which emit hazardous air centamimnts as defined by the Bay Area Air
Quality Mawgcmcnt Disltict7
Yea ❑❑ No
ihavcreadthehazadousmaterialsrequlm=nMunderChapter6.95of
�-I"►jE./'
BOILER-CDMP (3HP OR 100,000 BTU)
BOILER -COMP (OVER 100,000 BTU)
the California Health & Safety Code, Sections 25505, 25533 and 25534. I
understand that if the building does not currently have a tenant, that It is my
responsibility to not lfy the occupant of the requirements which must be met
p
City (lf rIlnarll11f)
NEW RESIDENTIAL MECH. SQ.FT.
prior to issuance of a Certificate of Occupancy.
`' //�1''I
ISSUED BY: v ' I u VUR
Ownerorauthorized agent Date
TOTAL:
OFFICE COPY
U