S 2464APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUIaBRTINO Stuff ,nmc. ELECTRICAL PERMITNO.
ItI11I,DING 111V[SION APPI,ICA'PION/1'F,R11IT s s..1-PLUNf!I+LMr�. -o Iv -MECHANICAL
-1. Iehl ssas S 2454
333 !V r SIE C y5U/ % I/ 2 6
.ARCUITTCI'A
NGINEER: LIC O:
ADDRES.. (i J/ /'W e
CONI'n PHONE:
� -72-?7
2 7
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❑ Consultant Foes Paid by Applicant (Initial)
BUILDING PERMIT' INFO
BLDG ELECT III.Ub11i, ME❑CH
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LCHNSED CONS RAM' IRS D:CIA NDON
I bunny aflirrrr mat 1 adrr uadraed tions pm�i.nrrl m r-napnr 9 (eanrdaeae;ng
with Section 700) ofUividon 3 aOhe Business and Profession Cork. and .51 cense is
ialiillIne. anJc
License Cl s.1 w - 1ne
Da¢ Comrucua
QTY ELECTRIC PERM IT FEE
JOB DESCRIPTION
RIiSIDENTIAI.:
❑SEDWI. O KITCHEN REMODEL
❑ADDITION OPLUMBING RE.PIPE
OSTRUCTURAI.
h10UIIBCA'1lON
❑INTERIOR OCHIMO
IMPROVEMENT[]SWIMMINGMING MING POOLS
PERM] ISSUANCIi
AI'I'hIANCIS-RCSIDENI'IAI.
ARCIIII'EC'1'S DIiC1,AR+ I'I N
cnJ my n plashall be uvJ xs puM1lic mends
I undrsn
PANELS
01
UP 10 2AMPS
hLicensed Prolcssinnul
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OWNER rBUILDER UI he ConTION
I hereby, (So,, to 1 am exanpt Irnm IM1c lec,io o Licoue law finite
following rcunon. ISccllan 91131 5, liminns and Pct. dena li Code: Any city nr counlY
improve. Jemn it t art l-iir nd swnum
which myuims a permit re She
cyto I 1: y .Ihapplicantf hpc tl 11 -g J:I l mem
rhu111 Incensedp I dl p ': I'h C t t "I I' (Clp¢rr
(commenting x'm Section 7000) ofMsison 3oflhe Business and Professional Code) 'it
drathe is canopl Ilmrcfmm :mJ the hwis for the alleged exemption. Any violation of
Section 70315 by any applicant for a cumin subjects the applicant to a civil penalty of
m more than five hundred Jallam (85(1(0).
nflhu pmpcny. nrmYempinywewim wngcunumeir,mlc cnmlrcmvtion,
will do the work. and thextmcmm isnot mendcdorsdt'emd Bvmle(So,. 7014. Dolmans
and Profcillmns CWe: The Cammeors License law does not apply w un owner of
pmpudty who builds arampmves Ncmou, ral who docs such work ninwlRe Ihmugh
hie own entploycen, prnaided Oat such impnwement are not intended nr oOkrN for
sale.If. hawever, the building or improvement is add within one year ofecmpleti ,'he
O BATH REMODFIJIUVAIR ODEMOUTION
❑ (YI'HI:R
OVER 1000AMP4
SIGNS ELI?CI'ItICN.
SPECIAL CINCUIT/MI.
� (�
TEMP. MI --I IR OR III.'I'
COMMERCIAL
ED NEW I3I.DGIADDITION ❑ DEMOLITION
OTL'NAN'1' ❑IcOOD SERVICE
IhIPROVEMEN'I'
OUTHI?k
St
POWER DEVICES
SWIMMINGPOOLELECTRIG
OUTLISI:S- SWITCHES -FIXTURES
NEW RESIDFN'I Al. ELL'C'IR tip P1.
SQ, 17, FLOOR AREA
SISQ. I'll
owner-budd r Is 11 have the burden of proving her he did nal Ind11d or impawe div pur-
'In FAh:
Luc of -red.
❑ I, as owner of the property. an exclusively contracting with licenced common to
QTY. PI,UMEING P17RMI F FEE
a...mn the project (See. 9044, RaIllocas and Professions Godo) Iare Cnntru todr. Li -
+M Lewdaesnot apply manowncrsd pmpen, who hand,, or impowesmemon.and
who urmmns f(,rvu-h project withacammno,o) licensed palliator ""he Contra, is
PERMIT ISSUANCE
Llccme [,xw.
❑ I.. csanpt under Sec. . B R I' C far this reason
ALTER - DRAIN k VENT - WXI ER (EA)
VALUATION
Uwe
WOR KERS CO.MPHNSAI'ION DECLARATION
BACK MOW PRUI ECF. DEVICE
•Owner
1 hereby atlinn under, penalty of perlodry enc nl the following Acdareunns
�Ihave:aJwfllnainainaCcrtiGetcofC'anwnl told!-ireumfar Worked C'ampcdd-
DRAINS- IROOR, ROOT; AREA. COND.
STORIES
'IYI'L'CON S'fltUC'IION
anion, as pa+ idcA for by Section 3000 of the Labor CWe, for the pefannence of Ibe
wind, Ibr which thin larmn is Lasunf.
FIX'IORES -PER TRAP
GAS - EA. SYSTEM -1 INC. J OOIIAO:SFTC.GROUP
0 1 have and will maintain Worker's Compensation Insurance, as squired by Section
370041he L.NoCWc. forme Nrlitmanccofine work for which lhispermir is issued.
AIN
GAS-EA.SYS'DiM&OVER4 f:
y W'nrk•Con wnlatiylI lam ncc curricr:md Policy num I r��ry�-�
policy
GRFASIVINDU51'RI, WAS 113 INITIRCEYI OR
19CAI'li P EXEMPTION 1ROM WO KI.
COMPIINSXI ION INSURANCE
BUILDING DIVISION FEES
GREASE IRAP
PLANCIIIiCK ITE
Tmilseaion need nor he, completed ifmc permitkfornnc hundreddollurs IS RISE
nr Ices)
SIIWER_SANITARY - Sri IZM EA.2011'. Q�
13NI IN GY FEE
I ccnify that in the performance of the work ka which this p roil In1,.ed, 1111',11'
not employ any person many manner so as m become sahjccl m the Worker.' Cnmpcn-
W61'13R IIEAITH W/VF.NT/IiL[CIR
WA'I ER SY5TEAVI REATING
WA'fhR SERVICE
ONADING PI3E
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s:ni,,nl,awsaf Calilbrnia.D:;te
Aplicant p
NUI ICE TO APPLICANT: IL Shellacking this Cerificale of F,se anion, you shoufd
beer e smjevl m the Worker's Cnnlrysnsmion pre Binns of me LuMa Calc, you mea
!amply win such Int dsdnns art this permit nbull be dccnaJ ruvakW.
CON S'IRUC[ ION LENDING AGENCY
Thereby affirm Ihm there iso emswerion lending agency liarrbc perliemm�ca of
the work for which this permit is issued (Sec. 3(197, Civ. C.)
Icndces N;, c
Sf111S FIi13
PAID I tcociprro
NEWRESIDE IALPLMIL SQ, FE
'RYI'AL:
'I'O' 1
Iimdcrx Addmss
BUILIIINI I EG
1 ccnify!hal I lose read this application and state Bra the ahn< infatuation is
cormcl.I agree to I nT1y with all city and -aunty ordinances end scale laws rcladng m
building eonsuunion, and herchy awhorice represemmives of this city [I) enter upon the
Q'T'Y, MECIIANICAL PERMIT FEE
SI3ISMIC OiIi
PERMD' ISSUANCE
FEE
:1.FCMCAL
above-mentioned property for inspection put loses.
(We) age In save, indmnoify ;sad keep In Iles dm City of Cupvrino ugninsd
liahiliries, juJgmcros. sults vnJ expenses which may in anyway.accmc agaired-id City
ALIERORADD'IIIMECI
I .IMinmm'a¢nceof
thegrainingof Ibis porn"APPLICANT UNDP I'ANDS ANI I. CUMPLY WITH ALT. NGN-PDINI'
AIH IIANOhINC I1NIT('it ,1 00CFM)
GISUURCE
H[GU ONS..^�AIR
HANDLING UNIT(( RI0.1 h
NSSigned,
pv nUCoat for Dam
EXHAUST IR)UD 1W/DI II')
)US
HAZARDOUS MXIFRIALS DISCLOSURE
Will the applicant or future Buildingneer,en, hoe or handle hrrohn-mweial
111311'1 NO UNI'I'(1011x1 I( ;'•I'(1
s defined by the Cuper ino Municipal Code, Chapter 9.17, and the Health and Safety
Code, Sellin 12553'-1N7
p Yen ✓
HENUNG UNIT (OVER 10,000 BTLE
[AID pare Hareiptp
VEN-St" PAN(SINGLE BES] US
Will Ine;pplicunt or folate building rccdmanl we cyuipmcnl ordevlas which
nagee
aMamm
emit hvardoes an, cnnmdnirant, a, defined by the Ray Area Air Qulity
Hl11LEk-COMP 611P OR I01.I11N113'1'U)
)'
Millner!
BOII.ER-COMI'IOVER 1110.000 SITU)
(,.�/
❑Yes L
AIR CONDH IONER
ISSUANCE DATE
Ihave acral the au,ralous mwerial.l requitcnmm. under Chapter 6.95 of the Cali-
NEW REMIDEN'II Al. MECU. SQ. FI'.
l omia Ilea11h A Snict of See '''^�' 25515.255)) and 25534. 1 notes, If Thal if me
M1uilJinB Ines no,m IY huse/o ¢'rJ/nt o+r ilivny mspnrymnrnifY rhe oecupam
nl IM1c n't sura Iiehd Y/I+yf I la lixr+'Jlrce al .r Certllia"ale of (k'a'upurry"
/Y�I�
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TOTAL:
b/I,are
I ISSUE[) BY.
Owner art vwhnrreeI age nt/
OFFICE