29099APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITYOFCU ISION nn".BufLuoNG-MECPQ(cA�.'rnv PERMIT NO. 29 99
RUILnINc nIVINION APPLICATION/PERMIT PLUMBING-MF.CHANICAI.
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OFFICE
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Consultant Fees Paid by Applicant (Initial)
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LICEN. ED CONTRACTOR'S DECLARATION
1 hereby aRrm Na I an licensed wader provisions of Gbapmr 9 (commanciag
with section1g07 of Division 3 of the Rosiness and Professions Cale, and license is
in full diceorce 0b0Unnd ct. y
License Class Lic.N
Dasa Contractor
ARcinmCr'S DECLARATION
1 understand my plans shot[ he used as public records
QTY. ELECTRIC PERMIT FEE
JOB DESCRIPTION
RESIDENTIAL:
❑SFDWL ❑KITCHEN REMODEL
❑ADDITION C1 PLUMBING RE -PIPE
❑MULTI -UNIT C1 STRUCTURAL
MODIFICATION
❑INTERIOR ❑CHIMNEY REPAIR
IMPROVEMENT
❑ BATH REMODEL REPAIR [I DEMOLITION
❑OTHER
PERMIT ISSUANCE
APPLIANCES - RESIDENTIAL.
PANELS
UPT02WAMPS
_4��
�5W J..J1
W 6
Licensed Profeam... I
Oot I un eU rapt fr OEthe CmumeltRAI
I hereby afErm ,het I um exempt from the Cnmracmr's License Law c the
whichingrcvsaparett lonstrut,aite,impr Professions Cu de: Anycity cc my
201-11100 AMPS -
OVER INM AMPS
.
SIGNS ELECTRICAL
W�6FVF..
C y
which requires a permit to construct, alter, improve, demolish, or repair any arm emre
pour at he isscensed p W.mreyvirhe dr, applicant for tum Contract micea,le .a nadl aw(Cbromem
that be is licensed pursuant 10 Ne the Liaets.e 9
SP[CIAI. CIRCUIT/MISC.
TIiMP.METF:R OR POLOINST.
BLDG/ADDITION ❑DEMOLITION
❑TENANT ❑ FWD SERVICE
IMPROVEMENT
[]OTHER
A. CO
6 e e
_4•
>n�
Z6
of Division 3 0 Business eii al Cap¢.
or
thec,da.sn.dml. A., violation
thammencingwith erefoalOaBh basis far she
that he is exempt thertfmm and the basis for the ollegcd exemption. Any vialmion of
Section 1031.5 by any applicant for a permit subjects the applicant o acivil penalty Of
not marc than five hundred dollars ($500).
❑ 1, as owner efthe progeny, or my employees with wages as their sale compensation,
will do the work, wal the structure is o a intin ded oroffertd forsale (Sec.JBW. Business
POWER DEVICES
SWIMMING POOL ELECTRIC
W
and Professions Cao: The Contractor's LicenseLew does not apply to an Owner of
property who buil& or improves the...... d who dues such work himself or through
OUTI.ETS- SWITCHES -FIXTURES
_
',
his own employees, provided that .such improvements are not intended in offered for
sale. If, however, the building or improvement in sold within one yew ofcomplction, the
owneobuRdcr will have the burden of proving Not he did not build or improve for par-
��go'�y' ossowne Pnmmtling with licensed contractors m
i
L as owner of the properly, ton Business Cale The Contmmon,
o Business and
project (Stapply
NEW RESIDENTIAL ELECTR SQ IT.
SQ. FT FLOOKAREA
$/SQ. IT.
e Law d netrsuch plr teen who i
cense Law an property
of pmpeny who thereon, and
Q'I'y, PLUMBI PERMIT FEE
f�
seildsor;mpI. the
f
who nmtmms for such projects with a cnmmnm(sl licensed pursuanun she Cnnbuaer'n
iflua
License Law.
El am exempt under Sec. . H Be P C for this rinsen
DEC i A
d 1%
PERMIT ISSUA
1
Owner Dom
ALTER - DRAT V -ER;EA)
BACKFLOWP T EV
V
Ull Y Vi U
WORKER'S COMPENSATION DECLARATION
I-
I hereby atlirm under penalty of perjury one of the following dedamtions:
OXi
DRAINS - FLUOR,R F CO U
❑ I aneroid will mvma;naCeriGcamofCnnsemto self"insum for Wohar.Cnmpem
ration, as provided for by Section 3100 Of the LaWr Code, fa. N. .... form..... of the
STORIES
TVPECONSTRVLTION
work for which this permit is issued
FIXTURES - PER TRAP
❑ 1 have and will maintain Workers Compensation Insurance, as required by Section
Of
37M offle Labor Cafe, for the perfornmme Of the work for which this permit isissued.
My Worker's Compensation Insurance artier and Policy mm�her arc:
Currier. Policy No.:
GAS-EA.SYSTEM-11NC.J [3UTLET$
OCO GROUP
APN
GAS - PA. SYSTEM -OVER 4(L•A)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section neeJ not he rnmpleteJ illhe permit is for one hundred dollars ($100)
or less.)
GRFASFANDUSTRL WASTE INTERCEPTOR
BUILDING DNI. ON FEES
GREASE TRAP
PLANCHCCK FEE
Icenify Chain the perfomanmafthe work for which this permit isissued, l shall
nm employ any person in any manner m as m become subj¢ue the Wnrkets' Cnm..ero
$EWER -SANITARY -STORM EA. 200 FT.
ENERGY FEE
WATER HEATER WNEN'f/ELECfR
Z
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sotion Laws of CWifsmia. Data
Applicant
GRADING FEE
NOTICE TO APPLICANT: If, after making this Ccrificasa of Exemption, you should
became subjecno the Workcls Compensation provisions of the Labor Calc, you must
foMwiN comply with such provisions nr this permit shall be deemal revoked.
CONSTRUCT -ION LENDING
nutageAGENCY
thin iseco agency for the performance of
WATER SYSTEMITRPATING
WATER SERVICE
SOILS FEE
last
PAID Dasa Receipt#
NEW RESIDENTIAL PI -MR. SQ. IT.gFE
{A I-"
O
0.
r h
U la.
khereby
(Sas. 3097. Cie.
the work for which Nis permit is issued (Seo. 31191, Civ. C.)
which
Undcrs Name
Lenders Address
TOTAL:
TOTAL:
BUILDING FEF. Cr
1 ccrify Nm I have read his application and state that the about information is
cortec,.I agrte to comply with all city and county oMinences and ante laws rdmingm
M1uo,.-rucunntmetpre,erand herebyyaathoscmmtivw of this eirymemer upon the
QTY. MECHANICAL PERMIT
SIIISMIC PEI?
PERMIT ISSUANCE
ELECTRIC FEE
.have -mentioned to ty .,,.
inspirationifakeep h'
(We) ago In save, indemnify end keep M1amJes the City of Capestino egainat
liabilities,judgments, casts and expenses which may in any way accme against said City
uce of the granting of this pemsit.
in conseyem
ALTER OR ADD'[ 0 MECH.
PLUMBING FEE
AIR HANDLING UNIT (TO 10.000 CFM)
MECHANICAL FEE
APPI T UNDERSTAh- S AND WILL COMPLY Wl[ ALL NON -POINT
SO CLa EGULATIO A_B7LJ
'M /n//,/pr.
obake xT
AIR HANDLING UNIT (OVER 10,1X10 CFM)
CONSTRUCTIONTAX
EXHAUST HOOD(W/DUCT)
HOUSING MITIGATION FEL•
gnmurc of anVCm actor 4 Date
HA RD(3U5 MATERI 'DIS L
HEATING UNIT (TO 100,0110 BTU)
Will Ne up..[;cant or fmurc building oecupem store nr handle huzardnua motorial
as defined by the Cupwoun Municipal Code. Chapter 9,12, and the Health and Safety
Cale. Section 25532(.)7
HEATING UNIT (OVER 100,00E B9U)
O Yes FIN.
n
Will the applicant ar future building t use e t or devices which
Pp dby the
emit hanmdoua air contaminants as defined by the Bay Arta Air Quality Management
Area
PAID
Data Receipt X
1
VENTILATION FAN (SINGLE RESID)
BOILER- COMP(3HP OR I ICOM BTI.
BOILER -COMP (OVER 100..0) BTU)
District?
E] Yet ❑No
AIR CONDITIONER
1 have real the hazardous ander Chapter 6.95 of the Cali-
ISSUANCE
NEN' RESIDENTIAL MECH. SQ. FT.
fomia hh & Safety Cah. Sections 25305, 25333 and 25511. I underttand that if Ne
tions 2 5 5 2553 an e
Wil g no'twtcurrcntly h]j etrnatn.that;, is my responsibility to notify the occupant
of ummentLyyirOYI-be ryet prior to of a Certificate of Occupancy_
OFFICE