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S 0485 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OFCUPF,RTINO BUILDING-ELECTRICAL PERMITNO. BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL S 0485 BUILDING PROJECT IDENTIFICATION' BUILDING ADDRESS: lrl(J 1N�7 ^ _ SANr1'ARY NO. APPLICATION SUBMI'I-I'AL DATE IOS�,2� AlofL�t, Wo _�_ uaxL�/��a_ OWNS 'S HAS F.,r , . t �` .�1 , PHONE �� 0 RTIC/'OR' NAIYIE:G1_,ij 6 �IC.1J 157 NIf. CONI'NOL N /011 TECf/F GI ER: !�/ LI Y - AD R'NS: 6 ❑ out ,> \ AtA c16137 O' CODU � I-N 4a&ToSt-_ CONTACT: PHONE: HUI LDING PERMIT INFO 5•rFl, 1 ��`F�. �& A, B ✓ /1 po OIQq ❑ Consultant Fees Paid 6y Applicant(Initial) EL PLUrgllt mECH '�+ V CONTRACI'OR:S CGCLARA3TI-ONN (Y QTY ELECTRIC PERMIT FIiE . I hereby affirm that 1 am licensed under pro�tiions of Chapter 9(commencing JOE DESCRIPTION aZ with Section JIXX)orOn,...u.3oNw Basine1sun1Pr -a'ms Cem.mdmyIntan,e is RESIDENTIAL' �� full force and OlImt /o�A rye PERMIT ISSUANCE KUF p 7 � ❑S OWE, ❑KI'I'CHEN REMODEL Q U U hiceosc B.ic.p In6a Date Commctnr a' AI'I•LIANCF.S-RBSIUCNTIAI. ❑ADDITION El PLUMBING RE-PIPE AR HIT[C'I';S DECLARATION [I MULTI-UNIT ❑STRIICTURAI. ZOy2 tun rsmnJ my plan.awhall be used as public rmorJs PANIAS MODIFICATION UlIT02MAMPS [I INTERIOR [I CHIMNEY REPAIR Fmk Licensed Profe,email 201.1000AMPS IMPROVEMENT (]SWIMMING POOLS that I am c,cemOCyou the onus \ OVER 11%X)AMPS ❑BATH REMODEURF.PAIR ❑DEMOLITION O e Q 1 heresy alarm that 1 am exempt from the Cessions c :Anye city for the '3 06 U following reason(Section JW L5,Business and Pmfessionn Code:Any city or wumy SIGNS ELECTRICAL [I OTHER F which requires a Permit to construct,alter,improve,demolish,or repair any smmmm poor it)its issuance,also inquires the applicant for such Permit o file h signed swtemut, SPECIAL CIRCUIT/MISC. f } thin he is licensed pursuant o the pmvisions of the Contractors License Law(Chapter 0 W �� (commencing wins Section J(XxB of Di vision 3 of the Business and Professions Code)or '>,� THM R MB'TER OR POLE INST. COMMERCIAL: d y M Y that he is exempt therefrom and the basis for the alleged esempnion.Any Aoletiun of ❑NEW BLDG/ADIJITION EIDE A10LITION ^m Section 7031.5 by any applicum far npcmtit subjuns the applicannna civil penalty of \'POWERDF.VICES ❑TENANT ❑FOODSERVICE t more man five hundred dollars($50tp. - IMPROVEMENT -F+q< 1,as owner of the ❑ pnupeny,or no,employees with wages ux their xnl¢eompvmsminn, SWIMMING POOL ELECTRIC \ C O will do the work,and the structure is not intended muffered R4r.sule(Sm.70M.Business ❑OTHE u, �^ unit Professions Coale:Toe Contractors License law does not apply to an owner of OUI'LEtS-SWITCHES-FI%TURES propcny who builds or improves thereon,and who does such work himwlf or through his own moployem provided that such Improvenico s arc not intended or aflered for NI?W RESIDINTIAL 1J,ECTR SQ FT. sale.ILw-even the building or improvement is sold within one yearnfmmpletian,the v` \ SQ,FC FLOOR AREA $ISQ FT. uilder will have the burden of proving that he did not Wro humid or improve far por- poseer-bor WIIC.). ❑ I,os snviam of be p peo lusi ly trawfir,with licensed madicusam 'I OPAL:It A 'o mounted the project(S L/m Business and Pmf. :Cade:)Th C n sur-L'- si\ - - n -4 censeLaw does not apply n owner fp pony h blit: p c thereon, d QTY.' PI,UMBING'IPERMIT FEE 494 too who contracts for.such f 1 t. th a emvctm(s)Iimm,ed pursuant theC rut � - t �"+> 'm /� e License law. PERMIT IS, ^ �t bl�•s� ❑I am esempt under Sec. ,B&P C fonh s reason o_ b \\ j u ALTER-D - �g1llATE N Owner Dam �r77 WORKER'S COMPENSATION DECLARATION BACK F'LO CM#ffGVC s \ tpletlOn iN I hereby affirm under penalty of perjury one of the following decl.rations: MCI Mice rnmt ❑IM1avcund willtwinminuCenitimmof Canscnurself-insorcfor Worker's Qnnpem DRAINS- ' ):• C lass Ir, e.TO '1'VPE CONSTRUCTION satins,as hick this for ai Section 3JW of the IaMsr Code.lin the perhsrnance of the s G Rion), w rk far which this permit is issued 11 OR P I ❑ I have and will maintain Workers Compensation Insurance,asrequired by Sed. 3700.1 the laMnh nCoJe,far pn'o en .nce nof me work for whichh this permit is issued. OAS-EA. ' - CA •T- ---^"� OCC.CROUP AI'N My W.. o bar In m carrier and Policy r. Cartier: s Policy No.: GAS-EA. S"fE 1. F: ( 1 CEiRTIFICA ?OFE%EMPUON PROM WORKERS' COMPENSATION INSURANCE GRHAS EffND S TW M Ew:I i This section need not becomplemJ tithe permit is forone hundred dollars($100) ` BUILDING DI VIS ION PEES nr less.) GREASE `, PLANA EF,Ii I cenify mal in the performance mf the work for which this permit is issued,l shall sA not employ SEWER-SANITAR p yany person in any manner as subject Workers'Cnmpen- Y-SI s s1iNERGY PF.F. s..ime Laws of California.Dam Z 'z' WATER I 'LIiCT - 7O NOTICEAppift- ;PA NGpCP. G uj become i TO APPLhe Work es Compensi ti this Cenifimre of Exemption.you should WATER SYSTEM?RFATIN. h' become subject m the Workers Compensation pmvisions of the Lahr Code,you most IFC Lail `mss forthwith comply with such provisions or this perma,hal R deemed revoked WATERS : \2,• CONSTRUCTION LENDINGAGENCY NCWRFSIDpJVTIALPLMB. SQ.FT. - L7 !hereby xffinn mat mere is aconamdion lending agency Gsnhe perfnrmwce of `SrDate ReceipI4 the work lin which this permit is issued(Sec.3119J.Clv.C.1 Leader's Name �� W TOTAL Lemdern AJJmsv 'TOTAL: \� y 1 certify that I have read this application and state that the above information is - BUILDING PEE �\ V) model.I agree hs comply with all city and county ordinances and state haws relating tr QTY. MECHANICAL PERMIT FELE U mildmilemawnion,and herebyinthvirecrepirmeunvesafthls city mentor upon the 1 SEISMIC FEE \�\ alcove-mentioned property for inspection purposes. PERMIT ISSUANCE s`, (WO)agree to save,Indemnify and keep harmless the City at Cowman madman ELECTRIC FEE \\ - liabilities,judgmems,casts and expenses which may inany way decrueagaima,.id City AI:1'F.R OR ADO TO MECH. \\ in conamparse of the granting of this Permit. PLUMBING FEE APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNI-I'(TO 10S. .00)CFM) MLCHANICAh FIili �\ SQQ�BhRRP� /2, X17 AIR HANDLING UNIT(OVER 10,11!10GI'Af) CONS1MECHRUCALFEH % ` \ Signature of ApplicuH ARD rr - Date EXHAUST HOOD(WIUULT) HOUSING'MITIGAI"ION FEB? HAZARDOUS MATERIALS DISCLOSURE \ Will by the CmIcator futurebuildingCarlo, Chaptnomor handle I koldr and Salty HEATING UNIT(TO Itp.Opp HT11) •� m delitieJ by the Cupeninn Municipal Cmde,Chap¢r 9.12,and the fleahh unit Safety Code,Section 25532(x)? 1 III?ATINC UNIT(OVHlt 100,000 BTU) s s C]Yes ❑No VHWILATION FAN(SINGLE RESIDE PAID 1 N Will the applicant itnntfuture building occupant use equipment(it Receipt r devices which \\ emit hazardous air eonmmins as refined by me Bvy Area Air Quality Mnnugemvt eHOILL'R-cUMP(3HI'OR 100,1X11)BTU) \ cosit TOTAL: ❑Yes F1 No BOILER-COMP(OVIiR IW.gl1)BTU) I have read the himadous materials hapdomenls under Chapter 6.95 of the Cali- AIR CONDITIONER ISSUANCE DATE form.Health&Safety Cale,Sections 25505,25533 and 255 W.I unJcrsmmd that Tom NEW RESIDENTIAL MECH. SQ.FT, building Jaw not currently have a tenant,that it is my responsibility to notify alc occapam of the requirements which must he met prior to issuance of a Cenificale of Occupancy. s Owamor authorad.,car Date TOTAL: ISSUED BY: OFRCE