S 2800 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPE RTINO BUILDING-ELECTRICAL PERMIT NO,
BUILDING DIVISION APPLICA1ION/1"ERMIT PLUMBING-NIECIIANICAL Lo
Q 2 8 0 0
BUILDING PROJECr IDEN'I'IFICAI'ION J
BUILDING ADDRESS: SANITARY NO. APPLICAIION SUBSII'I'IAL DAII!
41333 VA 1 ,4vewVli�-- t?- 2- ?,q
NN :SNA Ili: PIIUNIi: CONIRACIOR'S Int LIC NO.
Stlb dEIL 2SS'(BSSIC cGNfkuL«
:PCI IIT GINEII �� I-1cNE:'2 ADDRESS: ElI
C(Tool. PHNBUILDING PERMIT INFO
❑ Consultant porn Paid by Applicant(Inidid) BLDG
ELEiCI Y PLIU—M1 H� MECIHJ
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT' F1313
I herehy alfrm mot I ata fcea.m under prolimm,of chapter 9 B'oo+meacmg ) JOB DESCRIPI'ION
Wap wile Sec'ion JUlXgofDivision 3ofmclluxincc,eal l'rofc,eion,COJc.andmylicen.cis I'I!ItMIT ISSUANCE 3s` s` RFSIDENTIAI'
J-,- in 11,11 force and effect. ❑SF Wh ❑KITCHEN R17 ODE
C U F Liccrw Claes Lic.p
6-u APPLIANCES sDDITION [I PLUMBING RE-PIPE
Q 4 D1,ic Coatraclor
ARCIII'I ITCI"S DECLAmnO;N ❑MULTI-UNIT ❑STRUCTURAL
Z p ti Z I understand my plus,shall be used as public rcarords PANEIS MODIIICATION
C)z UP 10 200 AMP.5 ❑INTERIOR ❑CHIMNEY REPAIR
F.F.W Licensed Pude,usel 201-I010AMPS IMPROVEMENT 0SWIMMING MALS
W NER-BUILDER DIiCIARAI'ION
Y OoVl!k IOIlOAMP$ BATH RI3MQDEI/RIiPAIR ❑DEMQLIT[ON
C C Q 1 hereby:dfirm nue lain exempt wont the Gmva<ndn h;ecnae I,aw for the
3 LLF following mason.(Suroon 7011.5.nosiness and I'mfe„ions Code:Any city or county SIGNS ELECTRICAL Ili
N which rc9mre,a permit m con an cher.+mpmv<,demolish,or repam uny ata bre
O P� 0I
1 pri�rm lb issu:mcu,u6nrcyuirca the upplicam lar arch pemtiuoflea,igncd,,ammem SPECIALCIRCUEUNISC.
Ilan he is licensed pumunnito the pro.....O,ofthe Contracmr'x h'mcn,w Law(Chupmr9
1+1�C0 (commencing with Section 700)ofDivision 3 of the licone—ad Pn,fc,mons Code)nr "rHmP.MEI'EHORPOI.IIINS'1'.
6 6 e 5 Ibar he is exempt therefor.and the basis for the alleged eannption.Any vialmion of O NI BLOCUADDI IWN ❑DIi.MOLI'I ION
kmLL Samoa 70315 by any applicant for a Mnnit subject%the applicant m a civil penalty of POWER DE ICES
LL^m ninu+rcmun fvc hunthul dollxm($500) ❑TENANT FOOD SERVICE
�zQ
F1 L.,ownerof the property.army empla,tas with wages a,'Joel, o
ei,sale cnq+sm,ation, SWIMMING POOL HLEC']'RIC IMPROVEMENT
will Jo thewTk,..d thcuum
une is nor mandrJorsa
ndfered fole(Sm.AW.Business ❑OTHER
THI3k
6 3 m anti Professions Code:The Cummw o
nar's LicenLaw doe,not apply to an wner OUTLETS-SWITCHIiS-Il%TORTS
pmt rty who builds(ir imPro es thereon.and who dive.such work himolf or'hrnu h
his own e;npinyccs,provided thou welt improvcmenL arc nm intended or offernl for NEW RESIUEN'I'I AL ELLC'I'k SQ ITT
mole.IL however.the building or impmven+ent is add within tone vear of cnmple ion.the SQ,Irl'.FLOOR AREA $/SQ.I'1'.
-builder will have the bunlen of proving that he did not build or improve for pur-
,
inner-builder
- S�o6F7 1, : fthe pr1 ty exclusively t r swirl i 1 . +ct h; TD'1'nl.:
construct the poi (Se 7(Rt 11tivicessad Prolcosions Cole:)Ile C ' mor1i-
store, U-
store,Law doesapply to fproparty who build%or in,owe,flicreant, d QTY PLUMB GPF I'1' FEE
who ' 1,. I' chp ma' 'th nh ' OI Ipu. u d Contractor's
Lavnv Law, 1'FRMIT]SSUA C, "ov355
= '
O l.,is exempt under Sac. ,B&P Cl or this reason
AI:TIiR-DRAT VLN ER(EA) VALUATION
oner Use
WORKERS Sack,ol N$.,on OfteAollwinN HACK FLOW I'ItOT:".DEV[ O
1 M1and will
under Certify oe of Con mm 1,l'the In sum ing declarations
co
0IM1ave and main mi nation 37uteofConwnnn so6,forthe Worker's C,of the DRAINS-IIAOH.ROOK. 'A.CO' S'TORIS '1'YI'E CONS"I'NUCI'111N
amion,as provided for ni Section tp10 n(the LuMr Cook,for the perinnnance of the
work iia which This Ccnnit is issuedFIX'T'URES-PGR TRAP � S
I have and will reman In Worker's Cmnpan.ation Insurance as rcyuined by Sta i.
3700 of the labor Cure,for or
e ver -carce of me work for which this pem+it is issued. GAS-EA.SYSTEM-I INC.00OI'IJi1;S
bOCC.GROUP APN
My Worker's Compensation Insurance carrier and Policy mmnher are:
Cwricr: Policy No.: GAS-EA.SYSTEM-OVER J(W) (iJ y
CEM AFICA'TE Op EXIiM MION FROM WOR KERS'
COMPENSAUON INSURANCE GRUASEVINOUSTRL WASTE IN'I'ERCEMOR BUILDING DIVISION FRES
(Thi-action need not becan+pletedif the Mrndis fofouchundreddollmsUO(M) GREASE TRAP ,� / 0
To,lcs.l 1 N
Imn'd'y lha,in me Mrfonnnsceufthc work l urwhieh l his Fcnpi'is i.sucal,Ixhal SEWER-SANITARY-STORM EA.200 ITT
not employ any Moon in any mmoner no es it)Mco n,subject 1,l the Worker:Compen- I',gfyV' lel
O Z motion fax's of Calif cn ia.Date WATI!K HEA]ER WNEN'I'/HLECTR GRADING rIzE '
77 O Applicant
G � NOHCE'10 APPLICANT:If.all raking it...CcNGcamof Eacmpulao,you xhotdd WATERSYS1FMTRb[INC,
> fcvoine bjen+the Worker,CmnMnatfioe provisions o11hc labor Codc,you nm,t SOILS PI!E
suct
{Ia forthwith comply with such provi,ion-nn,petnahshall he drained revoked. WATER SERVICE
r
aQ
CONSTRUCTION UiNDINGen AGENCYagency
NEW RESIDIINTIAI.PLMB. SQ,FT AIU
VQ Ihttchy nffmulun there iso cnns'mnlnn lending agcnuy for lee Parfurmancc 1,l Uma kcccip'M
R. F the work for which this Anne i,issued(Soc.3WO.Civ.C) Q
U bender',Name
TOTAL
I 1(11'A
,r Lrndcr' Address
y ¢oily mm have read this upCllcunnn and xmm mut Rte stawe infnnnmion is BI]ILDING IIiE 16'O
�f/0 correct.l agree to comply with all city and county oniraneea:md state laws mining to QTY. MECHANICAL PERMIT 11313 yf
- gcoro hereby representatives Y poo SIi15A11C(Bili
V Z building wcUnn,and hereb Nhnmere mtrvn of this cit menmru the
uhovo-matnlonel pml+cny for inspcctiun purpnuc^. PERMIT ISSUANCERLLCTR]C ?li
S Q
(Wc)agree n,save,indemohy and koe,harmless the City o1Gy+enlnn against Il
liabib'ics.jntlgmcn”,nmmand cxpcnvc.v which may in any way accrue against said Ciry AIXER OR ADUTO MECH. PLUMBING FEE G�
snlucncc of me 6reming of this permit. r
APPLICANTUNDERSTANDS AND WILL COMPLY WITH ALL NON-POIN"T AIR HANDLING UNIT(TO MOM CFM) MECHANICAL FEE
SOURC17 RI!GUTAI ONS.
AIR HANDLING ON['I'(OVER 10,00X)CFM) CONST RUC'IION'1AX �3r
Signature of Applicant/Contractor D.I. EXHAUST HOOD IW/DUCT) HOUSING MITIGATION PEI!
IIAIARDOIIS MATERIALS DISCLOSURE
Will the upplicu Iur future buildingrx:o,erl,ha,or In die havurdou,material IR!AI ING UNI"T(TO III WO BTW
ua defin,vl by the CuMninu Municipal Cole,Chapter 9.12,and he Health and Safety
Code.Section 25532pV HEATING UNI I(OVER 11000 RTU)
❑Yes 0N PAID /�-O
VENI'l1.AfIf1N PAN(SINGLE RIiSIID p1, Rccciptp
Will the applicant or future building occupant use cyuipmem or devices which BOILER-COMP(1111'OR 1(0.1X0 BTU)
ut haneri air conmmitmm,as defined by the Bay Area Air Quality Managemcm 'Hy11M.:
Trioti. BOILER-COMP(OVER 1 W,IR 01{'TU)
❑Ycx E]No
I have mad the hazardous material,"trinanent,nuke Chapter 6.95 of the Cali- AIR CONDI I'IONEH ISSUANCE DATI3
0 ramie 121b&Safety Cale,Semon,25505,2553)and 255M.1 understand that If me NEW RESIDE1,71AL MIiCH. SQ,PC �O
b1,Jding Axav no'currently have a
I.Thin it k no,resptonniMlity u+oatity the o"U1.011
of the rc9uirc;nano.which moa Mmol prior to iau:tnec of a Ciard"ac of Occupancy. C/
Owner ormlhomedagcm Date TOTAL: ISSUEI)BY.�joe /-'r/%''IL�/C�'••
OFFICE