S 2301 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
- IIT •OF CUI'ER'1'INO BUILDING-ELECTRICAL I'IiHMITNO.
I. NC DIVISION APPLICATION/PERMIT PLUMBING
PROJECT IDENI IFIL O 2301
3 0 4
ItUIL111NC.1'ROTF.CI'IIIEN I'IFIG\TION J 1
rI{U: BL•SS fiANIIARV No. AI'YLICAIIUN Sl113M1I'IAL HATE
s III cur. m /o - >-g8
OWNER;SN MIT.PHONE: CONTRACT 'S NAME: LIC NO NIC CONTROL#
`—b Sfo 5
III'11iC1'/ENGINEER: LIC NO: ADDRESS: ❑
�► s.J
CONTACT: PHONE: BUILDING PLRM1'I'INF0
L ❑ Consultant Flaps Paid by Applicant(Initial) BLDG ITT ECT PLUMB MIT it
00 ❑ C� ❑ ❑
I.ICENSEIJ CON]RACIOR S DECLARATION QTY. ELECTKIC Pi:RMI'f FEC
I hereby anima mat 1 ant licensed ender proei.itn.of Chapter 9(mmmcreing JOB UHSCRIPTION
CO withSection]0001of Dlvislon 3of[hc 13mine_—dal Pmfesdors Code,rwl myliecnw is RFSIDFNTIAI:
4100 I'ERMI'I'ISSUANCIi
FW• lull force and elfect ❑SPUWI, ❑KITCIIEN RIiMOULI.
aUU dl�icen.mC� �'- Lie to APPLIANCF_S-RESIDENTIN, ❑AUDIT ION ❑PLUMBING RE-PIPIT
F Z ly Dane Cunvnnor
tnQa MULTI-UN['[' (_1 STRUCTURAL
ARCIII'IIiCTS EHCI.ARAIION
,c,p y I'ANIi1S h10UI1:ICA'110N
OZ4-m IunJerswnd tnY plum sM1all he mcJ a.Public reeMs UPT0200AMPS
El INTERIOR ❑CfilMNfiY REPAIR
I-'nf-4,1 Licensed l'ndc..ional 201-HXXIAMPS IMPROVEMENT SWIMMING P001S
OWNER-BUILDFR DGCLARAI'[ON OVER ImOAMPS ❑BATH REMODEUREPAIR ❑DEMOLITION
C C Q 1 hereby tdlirzn Ilial I ant exenpt Irons the Gmuacnd.Licence law lin'hc
y O
woe:
❑OTHER
folloxing,nano.(Section 9W L5.Ilusinrzs and Professions Craft:Any city or emn'YN
CTRICAI• Z "z0
{t13 U.i- which natdras a permit m construct,alar,improve,demolish,or open,an, lanture A 1
F'u'OQ prim ao'ns issuance.also rcyulre.ILc upplicum fnrsuch parmitw Elc a.igncJ s'nammat CIRCUIT/MISC.
ISC.
Eby' that he is licensed L aouam m the provision,of aw Contralto's License law(Chapter 9
�L�'�p lootnmtnuing wlth$mainn pIXlU)ul Oivisinn3tf'bc Bassen..and Pmfcasinm Codc)orER OR PO I,LINST COMMERCIAL:
ti a y' that he i.exempt therefnnn and the bliss%fur 0e alleged cxcmptinn.Any violation of ❑NEW BLDG/ADpI'I'ION ❑UI OLI"PION
p(�a Section 903 LS M1 permit subjects the applicant to a civil pendry ofF.VICES
4:�m y any applicant for 1 ❑TENANT ❑FWD SERVICE
not marc than five hundred(113112tH(S510). IMPROVEM17NT
_� Ol.aowner of the progeny.or my employees with wages as mese see nnnpenvainn, GPOOL ELECTRIC
F• will do the work.and flon,aucturc is nmimandrdoalTcred fosatc(See 70x14 Bnsinc.. OTHER
W G w nnJ I'rnfcndnnw CtWc:'I'M1c Cmnrnt7niv 1;astxc law ores not aPBIY lu an nwnrr of -. T'II!S-FI URESprnpeny who build.or impmves thereon,and who d«..such wok himelfor thnmghNsown empltyces,psoided thin such hnpmvan Ira,arc not intended ser dfacd forDETTF1A '!R SQ F'I'.ole.If,howvtcthcWildingurimprovcnrem iv wld wilhinnnrycarnf cn.nplenon.theSQ.FT.PLOOR AREA S/SQ.Irf
owner-builder will have the burden of proving that he did not build or improve for Pur- ^Ori oaf n:dcle of the pmpcnY a xcluvively contacting with licensed contractor,to '1AL' ir
Vrmtuct the project(Sec.AYW,Business and Profession Code:)The Contractols Lhcense law docs not apply m un ow net of sn,wim End In,a,hnprovcs thcmon,zonePLUMBING :RMIT FEE
who comracts for%uch pnrjec'%with a mntreemr(%)licensed puauum yr the Convannr'.
Limon LawPERMIT ISSUANCE
I rat exctnp'undcr Sec. .It&P C ka Ihk rcawm
ALTER-DRAIN&VENT-WATER IRA) VALUATION
,. Owner Date S :
WORK1 COMPIiNSA'][ON FLUE ARAI'ION RACK PLOW PRMECI'.DEVICE
1 hereby union under penalty of perjury one of the following declaration..
-Ihave and wdjulaawin a Ccrtif,acolconscnt tnsclFlnsary Ger Wurkcr's Camper- DRAINS-FLOOR,ROOF,AREA,CONE. STORHis TY PI!CONSTRUCTION
.noon,as provided for by Section 39110 of the lahor Calif.for the nationnance of are
work fm which his p neat is issued FIXTURES-PER TRAP
I have and will mvimein Woke(,Contpen.ution In.uonce,as reyulrel by fiction
3700 ofthe Labe Codefor the perfomance ofthe work for which this perznh is issued. GAS-IiA.SYS'I"FM-I INC.J OEM LE OCC GROUT' ALIN
My Winker' C nap nm'i won 'carrier and Policy nu
Count,: Pali,sho, 3 r i GAS-EA.SYS"TEM-OVER4LEA)
C13RTII'IATE OF EXEMPTION FROM WORKERS't0, 'C. GREASUINDUSTR1,WASTE ILTGRCEPrOR
COMPENSATION INSURANCE BUILDING DIVISION FEES
(]Joe,Sienna need net be IT ladocd if the permit i,lin one handfed dollars is 100) GREASE'FRAP -- -
I'LANCIIIiCK 19iE
as os.)
Toy any manors in anyvenner,on,In Ii for which his peons i.n"Counte- SI?WI!R-SANT TARY-S'f11RM IiA.21X1 f9'.
not employ am person in any manner so ns m hecto,wnjeaa m me wmken<eoadln�n- IsrvltRGv FEE
Z xxtion laws odifcra ia.Dalt WATER IIEAT17R WNENTIELECTR GRADING FEF.
Z O Applicata
NOTICE TO APPLICANT:If,after traking this Cenifica c of limmption,}ots%broad WATERS iM/I'kEAT
^ SOILS PL'E
Lantana,subject tit she Workerro Cumpcnranan erunt slat of the Lubn,Code,you mot
I 6t ~
forthwith urmply wi'h.uch prnvixionv or Nis pennu doll he Aucmod evoked WA'lTilt Sl G
�1
D7
CONSTRUCTION LENDING AGENCY NEW RES -'TAI, PAID
'7 Z I hi dfimt lhatlhere is a em.amtion lcodingagency for the performance of Uuw kccaipsp
r- the work fof which thin permit is i.wrd(Sec.309).Civ.C.) PIUILDINOF
Lnder',NameU ender%Address 'Il)TA L:CI certify that I have read thins app[icatinn and state that the above information iv N cvv, l ercrm cnrdply with ill shyami ccOny ashntmtcsand swan Wwn relating ur Q'IY FEE,Z building constsuctioa and hereby authorize representativesofmi.city invader upon me abovc-n en inand property lin inspection purpoms. PERMIT ISSUANCE -(We)agree bees,,indemnify and keep ha tnlens the City reit Capelin againstIiubiliaice.judgmenu.costsandexpenses which may in any way accouc againstsaid City ALTER OR ADD*U0 MECB.is .acnccnf me grantingol''his pannus
AI'I'LICANT TIN ERSLANDS AND MLI.COMPLY WI'1'11 ALL,NON-POINT AIR HANDLING HAT p(TO 111)X10 CFM)
Is
SOU C, ;GUI TION' ,
Io AIR HANDLING UNIT(OVER I0,000CFM) CONSTRU ON TAX
Signaturcof Ap is MC ornmmnr Duro EXHAUST DOUG OW/DUCT) HOUSING SEE IGATION FEIi
HAZARDOUS MAI ERIAI S DISCLOSURE
Willdhe plicamnrfusum Ni[Jingtncupandstt)mo,handleha,�nusmaIerit PTINGUNITTO 100,N)OBI'U)
ns dulimnl by'hr Culnnlnn Municipal Code.Chapter 9.12,and the Ilealsh and Safety
Coda Section 2553240? HEATING UNIT(OVER IINI,INN111'IV I
❑Ye, rYNn VENTILATION PAN(SINGLE RESIDE PAID
Doc Receipt a
Will she applicant or furore building occupant use eyuiptnemor devices which BOILER-COMP(311POR LUU.UINIBTU)
ha,ardoun air consaminuma as defined by the Bay Arca Air Quality Management TAL: 0
)Tian'! BOILER-COMP(OVER 100.0)(II BFUI
C3 Yet ,
x" AIN CONDI'I IONT:R ISSUANCE DKFE
' 1 have rceJ We hurarJnun nwarinly reyuimnanl,under C'hupltt 695 0l the Cull-
fomia heath&Safety Cede,Sections 8505,25533 and 8534.1 understand that if the NEW RESIDENTIAL MECIL SQ.IrE ^ ��
buil dingdocsmlcurrentlytrv�umnank mal it i%'ny reslxmsihilhymno'ify the aruMml
of r ion which tMmed prier er isuancc�da Cc Ilse, nl(kcu� ,alley.
owner or amt ri,. lagena O Dtnc ISSUED BY:
OFFICE