S 2057 APPLICOMTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
•CITY OF CUPB.R'1'INO IIf111.DINC.-ELFCIBICAL Pli IT NO.
BUILDING DIVISION APPLICATION/PERMIT' rl.urvunrvr.-nlEcunNlc,+1, 2057
nuu.lnrvr.rlcontcf uaalvrDTarrum
DIl JANGADDRESS: SAN]CARY NO. APPLICATION SUHMI I'I'AL DATE
0 1 do
1 x'-25 "a
OWNEH:S NA,MI:. PllU. li: CO RACIOR'S NAM([: LIC NO:
ZZ E6VE N/ ST GS`►/o NIC cGN xol.a
ITEC(' �NGINEER: LIQ" At RESS: Y2 ❑ ��/O
-.•(i 7i ?� UI EPPE tT. o5 le V1 wE N ((/
GONIA"1't PHONh BUILDING PERMIT'INFO
Ou 6f : 5634=71 7,24Ei3 ❑ Consultant Fees Paid by Applicant(initial) RLI% LECT PLUMB MEGA
s 1014 "-)-a 1S • ����
I.ICENSED CONTRAC]OR:tiECIARAI'ION QFY EI.ECTRIC PERMIT HI:E
I hercby action that U am p
licensed mater mri'Aor,of Chapter 9(commencing JOB DESCRIPTION
,il all force uoddlol Di nano Sof the Hudncsmbd 11 hosians Code.andmy hearse is ^ RP.SIDENTIAf:
wish Sr.'binn 7tH1(e of
pyp J /D� I'[Rn11f IS5UANCli
t. 5 �SI'UWI. ❑KI'ICIII3N RIiMODli1.
sect a s hie,a
Co APPLIA,NCE.S-RVaDENI IAL ❑ADDITION PLUMBING RE-I'll'li
5h AMI�ECI':S DECLARATION CONST 0� PANHI.S ❑MUISI-UNIT' ❑STRUCTURAL
y Z I mWcmand m,plana almll be used rs public read, MODIIHCATION
OZN� UP TO 200 AMPS ❑IN'I'HR10R 0C IMN Ey REPAIR
F�F-W Licensed profo.ionnl :el-IIXMIAMPS IMPROVF.MI NT 0SWIMMING POOLS
OWNI311-BUILDER DECLARATION OVER Ifxx)AMI'S ❑HATH REMODEUREPAIR ❑DHMOIJ [ON
Q 1 hereby uffmn that I um exonpl tram nm
the Cmemr's I facele Law fm the
K0aU following reason.(Section 7031.5.Business and Pmfcssions Ctxle:Any city or county SIGNS FLEM RICAL ❑DTIILR
W 3 LL IF which ooffnes a permit to comtmet,alter,improsc,demolish,or repair any structure
otA
J riolo it, 'l...tabour,thr,he II I t ,,lilac visaed 1un m I SPECIAL CIRCUI DMISC.
hill he licensed IF can, Ille pravi,jor-di'llue Cmarwlur I License 1 (Chapter')
QQ (esmmcncngwth Section 7(XXBof Divnan J.(,he Humus and profession,Code)or TCM('METER OR POLE INST. MC�(LMFRCIAE
d X o C Ihm he is exempt Ihcrcfmm and the basis fur the alleged exmnpti er,Any violation of ❑NEW t ADDU[ON ❑DEMOLITION
Section 7031.5 by any applicant for a pernutodjun,the applicant to a avil penalty of POWERDEVICES AN'f ❑FOODSFRVICh
not more Ihall five hundred dollars(53881. Int OVEMENT
SSC Q I,as owner of the propcny,or my employees with wages as their sole compel+tion. SWIMMING POOL I3LECI'RIC
p. will do dw work,and the,muummc isnot inandnfor n11—al loreale(Scc.70W,business ❑OTHER
3m and Professions Cede The Claimant's license Law doe,nol apply le,an awn,,,, W'I'Lli'I'S-SWI'(CHES-I I%'I'UltliS
proKay who build,or improves thereon,and who J«s such work himscB nr Ihroug
his can employees,provided INn wch improvement,are not inecoule or offered tar NEWNESIDEN]'IAL F,LIiC;R -
salcll;ho elle building nr linpro an iaenld within nuc ycunbfcwnplcLion,Ihu SV.p.FLOOR AREA SISQ.IT.
aw'nerbmldcr will have the burden of paving that he did not held nr Inbpmve for pur-
prew of 1.) UA
0 1,allow ocral the propcoNalm exclusively remosaing%ith f it concractot,s to /
tat t flat p t t ]eta d I : I )Tl Collimatorsli- meq/)
.xclo41 J t apple towner .. tory h bodes
improvesand Q1 Y. PLUMBING PERMIT PEE
who nt& such
pp leswthaabntmrctmklicensed
pursuant mCe
llnit puethe ammnh
L icence haw. PERMIT ISSUANCE - -
I in cxempl under Sec. .It&P C Inc flit¢aeon �"-
AUU:R-DRAIN&VONT-WATER(EA) VALUATION I
Owncr Data I1 /
WORKEII'S COMI'1?NSADON DI3CLAI MION HACK(LOW 1'ItIYTEC'I'.U' Cli
Ihereb1 aflirm under penahy of perjury one of the lollnwing Jcdarbtinns: D L
]have and will maintain a Cedificac of Consent it, for Wader's Counter- DRAINS-I'LOUN.R( .GOND. vyVLq_ JfYI'E CONS'FRUCI']ON
salon,ns provided lin by Section 371X1 of the Lahor Coda or the perbrommuc of the
walk far which thisparent itl...ed. tax I It11tIiS-1'131
0 1 have and will maintain Worker's Compensation Insurance,ns required by Section
3708 of the"horColic,f..he pachumance,of the work for which this pennies issued GAS-PA.SYS'IT -11 a .T. DEC.GR UP APPS
y Wader's Campenaainn In.mrance a,nill and[,ah,number are
`.Y'umcr; Policy No.: GAS-I?A.SYS]'IiM"OV EIta .N
CHRTIFICA'IT,OF E%13MPTUON FROM WORKERS' GREiASP/INDUS'1'RLWASTE INTiRC- R
COMPENSADON INSURANCE H ILDING DIVISION FEES
(Ihi,soedonnccelnolla.m.nptried it the permit lslor on chundteddollad(91ta1)
or less) PLANCIfECK hili
I,edify that in the performance ofthe work for which this perunil is issued,l shall SEW '1'1'ARY .TORM r. kFT.
nut employ any froba n in any amour so as to b:cuntc,ohne',,to the Workers'Compeer ENERGY FET:
Oz mmien lawsol Culilorrom.Date WA'13RHEANIRWIVENT EJ: 'I
O GRADING IIiIi
z O Applicant
Vj NOTICE"In AI'I'I,UCANT:IC after making Ihi,Ccnificam of Esemptinn.you should N YSin R SOUS FEE
H bceomc xu a ml m the WurIt o ,bm,c,do n provision,n e de Lubar evoke you,atm
if
4bnhwithcnmply withsudb pnrvisinnsarthispennit eball hJcmncd rcvoACJ. WAI'13N SERVICE o1a33
u]
II" CONS'IHUCTION LENDING AGENCY NEW RESIDENTIAL PLMH. SV.F[ PAID
Ifeet,al'linn,hmdovisumn.vudion lcndingrguncy for dm'ad'um.tor,of D c Recalls If
1 O P: the work for which his pernot is issued(Sec.3097,Civ.C.) 'I OTAL:
V fenders NamcduOT
I.cnr's Addu,,s t
r d 1 eerily that I have rend(his application unit stun,hal dea Nice In ....otion i. HUI 1 N '1313
F` to correct.)agree tab comply with all city and county ordinances and state laws relating to Q'I'Y. MIiCI1ANICAL PERM1IIT FEE MH' l➢i v?
U builJingnnstmetion.and hercby amhnriec mere cnmtives olthi,<iyemmerupbm the +
ubovcnwmimbeJ pmpttty fur lnsptt'fum Purposes. PERMI'FISSUANCE / 171 - RIC FEE
(We)agmc tab save,indemnify and keep hurntless Ila.CID of Cupeninc ngausl
liabilities,judgments.costs and expenses which may in any way accrue againstIC�ity LTI3R OR ADD TO MECH. 6(� PLI IBINGFEE Q
APPbwqueRteal"Ihcgramingofthispumiit. a/,
LICANT UNDERSTANDS AND W11,1,COMPLY WITH AEI.NON ( F AIR HANDLING UND'('10 IB,INx)CIM) M 'HANICALI H
5ollRCli RP JLA]'IONS,
d IR HANDLING UNIT(OV13R 10,(Np CFM) � CON.TRUCI'ION TA%
col Apph.m Comn,ctar ala P.XIIAUST HOUD(WIDUCq HOGS NC MI'I'IGATII)N I EE
HA%ARDOU: RIAIS DISCLOSURE
Will the npplicam or Enure Ain6 uccupam,Iore nr handle hwardouz material HIiATING UNI ryTO IIM,g1U B'I'U) O
us dx1 by the Cmpenino Municipal Cbdc,Chop¢-r 9.12.:md tM Ileallh unit Safety %
Code.
v.Sectinn 255J2(a)'I HI3A'I'ING UNI'('(001311 100.000 IfU) /1
Cl Yes ❑Na oe
VENTIfAT]ONPAN(SINGLERESID) ('AID Y
Da R a
Will the upplicam or tomer building arlanl nl use eynipmat or devices which BOILER-COMP(311P OR 100,1 r)(013IU)
in harardou,air communities a,refined by Ne Bay Arca Air Quality nlamagnnenl h.
ballet? FOULER-COMP(OVER 100,000 BTW
❑Yes 0N
1 have read the h olle,S s midetions 2 5 5,25.533 an ualer ,1 and(vu5 of the Cali-
AB CONUI'I'ION13N IS,l'UANCIi IJATIi
folia Health a.Safety Cmle,Sections 25585,p r, unit 3553x.I uedcli ry m(hut if the NI3N'RESIUI3M'IAL MECH. SV IT. / O sr'T 110
builAingdnc,nmcunci,y have amman.led oisnryrcspfmf arallonotity tM1u.ne". ,
of the reyuirancnM1 which Iona hs tan prior nb isamntt nl"u Ccnifcam of Ocn,penry.
Owner or anhmbcJ agent Dale YfA ISSUEDBY:
OFFICE
m
0
a
0
v a a a a a a a a a a a a
.L
LL
N
N.
oto. a a a a a a a a a a am m M LL LL a LL LL LL LL LL LL LL LL LL LL LL LL LL
y M M M M M Cl) M . . . N , N M N N N IT V � N N N N N N N N N N
w
C
O
a+
d
N ❑ ❑ ❑ ❑ O ❑ ❑ UUUUU (n (n ❑ ❑ ❑ U U UU UUU UUUUU UU
E Q Q Q Q Q Q Q U U U U U ❑ ❑ Q Q Q U U U U U U U U U U U U U U
m m m m m co m m co m m m m co m m m m m m m m m m m m m m m m m
c m rn rn rn rn rn rn rn rn rn rn rn m rn rn rn rn rn m m m m m m m m m m m m m
C r r r W O O O M M S (") M m W m N N O I� N M M M M m C 0 0 0 O qm
N N N N M M M N N N N N N N `- `- `-
0 0 0 0 0 0 0 \ \ N N N N N
N
m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m
W rn rn rn m m m m m m m m m m 0 m m m m m rn rn rn rn rn rn m rn m rn rn m
W O O O co M M m m m 0 m N N O O O O O O
I� N t� c� t� M t� \
d y N N N N M M M
W O O a O O O O
w ❑
� W
CL
� Q
Q. r
O
OI
z a
C J
U Q
0 Uz LL
vd V 2 z LL J
LU LU
LU 0 CL 2
C J
LL J J J O U J LL z Z LL LL
Z QQ Za' K QUO ¢ � LLLL L� W LLli w (i
W Q U H W LU CD om Q > > m 2 Q m m W U m m 0 W O m w U U
m J a' w w J a' a� U w m m U Cf W W CO II W J J W J J J J J J J W W
❑ W LL22w ❑ ❑ wn < < cn ❑ F- F- F- F- NO2mmmwmmw22
0
J
w
Lu
wwwwwwwwwwwwwwwwwwwwwwwwwwwwwwww
w LL LL LL LL LL LL LL LL w LL LL LL w LL LL LL LL W LL LL LL LL LL LL LL w LL LL LL LL LL
J J J J J J J J J J J J J J J J J J J J J J J J J J J J J J J
F- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F
N
0 0 0 0 0 0 0 0 0 C. 0 0 0 0 0 0 AIN
0 0 0 0 0 0 0 0 0 0O O O O O O O O O O O O O O O O O O O O O O O O O O
F
40 � OOOOOOOOOOOOOOOOOOOOOOOOO000000
w N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N
d U U N U U U U U U U U U U N U (n (n (n (n (n U (n (n (n (n (n (n (n CO U (n