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30873 '.APPLICANTTO FILL'IN INFORMATION WITHIN RED LINES-USE BALLPOINT PEN ONLY a t. CITYOFCUPF.RTINO BUILDING ELECTRICAL.., '•+ PERMIT NO. BUILDING DIVISION APPLICATION/PERMIT PLUMBwc MECHANICAL.,. 30873 BUILDING PROJECT IDENTIFICATION UILDING ADDRESS: i . - - - - SANITARY NO,- APPLICATION SUBMITTAL DATE D � �/c7��3S o%.2d C.4 �S©� UK— N?'S AMB: 'V\ PHONE: CONTRACTOR'S A 8' LIC NO: N/I CONTROLN RC41CTIENGINIEEK ` LTC No' J} ADDRESS: I "' ❑,' , WO L'IAAro, 09 CONTACT \ ON . EX„r23 +'• BUILDING PERMIT INFO ❑ Consultant Pees Paid by Applicant(Initial) �`�� � BLD 'ELECT PLUMB Mecx L ceNSED CONTRACTORS DECLARATION QTY. ELECTRIC PERMIT FEE 1 her by affirm that I dm licensed order-prQ s ,ns of chapter 9(commencing JOB DESCRIPTION• _ 'ad a'Z with Sat 7000)of Division 3 ofthe Bust a f .loos C.de,andm bcense l% ' WOO w p y PERMIT ISSUANCE RESIDENTIAL. F nfullf d ff t. V 7 nyT� ' ❑SFDWL ❑KITCHEN REMODEL �UZ V'Date Cl.. - LGN - 4'k r¢l0" �� , APPLIANCES-REMDENT1AL ❑ADDITION [I PLUMBING RE-PIPE h Q Dale Cont t - vy � ♦ ARCHITECTS DECI ARATIO syr� ❑MULTI-UNIT`, Fl STRUCTURAL Z p H R l understand my plan.shall he used p hbz rerorzls lk Z'1�/ ,', PANELS MOUIPICATION O•Z'-pp Y uP T02WAMPS - ❑INTERIOR, C1 CHIMNEY REPAIR W Licensed Pmlessinnal ' " 201-1000AMPS IMPROVEMENT OWNER-BUILDER DECLARATION OVER 1000AMPS- ❑BATH REMODEVREPAIR El DEMOLITION 1 hereby affirm that I am exempt from the Coul acne's License Law for the 3 6 U following .(S coon 7031.5,Business d Pr f: oro Code Any 1l'y"mYcnunlySIGNS ELECTRICAL LJ OTHER liwhich y - permit t „ It p demolish, p y tinct re � prior tot q th appy a tf r u hpe '11 fl 'g J 3 t ant SPECIALCIRCUIT/MISC. a'y y�yY that he ficLsedp a the previsions ofth Contractors Lice Law(Ch pter9 w Gd0�0q (commencing with Section7000)of Division i of the B s dP f Cdjotb" TEMP.METER OR POLE INST. COMMERCIAL: - n, p W that he is exempt Iheref d th b s write all g d e empC n Any lafon ofS ❑NEW BLDG/ADDITION' ❑DEMOLITION ^IL Section 7031.5 by any applicarTfort,permit subjects the applicant to a civil penalty ofs POWER DEVICES - 0 TENANT ❑FOOD SERVICE not mom,ban five hundred dollars($500) @@ IMPROVEMENT60 []I as owner of the proper,or my employe,,with wages as theirsole comae... -\,SWIM MING POOL ELECTRIC �-�, DOTTER will do the work and the structure snot inced I ff df sale(See7044.Business OUTLETS-_SWITCHES- `V 0.3 and Professions Code:The Contractors License Law does not apply to an owner of, v w FIXTURE e .. property h builds or' p th and h does such work hmself or through p his o ply pmv dad that such p t, o,intended.r coined for NEW RESIDENTIAL ELECTR N i Q ET _ - - sale.If however theb Id g p e o Y , il within.neye tf mn,ic int the '1 [ SQ. .P O AIInA $/SQ,IT. f owns builder will have theh ail fproving that he did ah Id p for pars .>� b 6 ", (/ TOTAL Ah 1,as owner of the property, exclusively ,stun%with n d i tore to �I 1� i M� RECD - sI de ' vconsw t thep Sect(Sec 7044 Business and Professions Code)Th Contractors Li ae La d not apply t an cement,fproperty I holds., mtherva and QTY. PLUMBING RE MIT wochancesf su \& , B P rePERhITISSUANCE Q •' - - - Jr W104 11 1 Ow. Date -G'^ `+'Ss VALUATION „ ORKER COMPCNSATI NDECLARATION BACK FLOW PROTECT DFVICE'' � s. _ ❑1he�ea awinmunelde c (I�y of orco�%e���o G���I�o r following declarations:Compeer. $U dJf�QfL �p P,n. 0011 ' sation,as provided for by,Section 37M of the Labor Cede,forthe performance of the n .�+� nn�� TYPE CONSTRUCTION work for which this permit is issued: -' - D 1'OYI f WP W `4s STORIES,'r - ❑1havecad au,Code Inertias, ver Workersance of Insurance,hrequired by Section a mac, rte GoTE8 }"tlY� 3700.1'the LaMn Code,for ihepe......neeof the work for which this permit is issued. e�Yp1 OMT Jpp �N•xlmlYn4pJ4/0�4Pp ,a\ t- • OCC GROUP' APN C. k p n [ n urance ameP lily Nf nr;, - ILII YnI M��uYl4WVY O . 'R IPICATP OF EXEMPTION FR 1WOR JCS ...1.1]L.n ERCEPI'OR - COMPENSATION INSURANCE- e{{!l44��NN®® 9 \`@� s ' 'NUIIsDING DIVISION FIGS PrOw (qh aci.uneodnotbecompleted fifth p 't isf.r.nchundreddonars($100) ��� I 4� Vspya ' or less) - H >'.l PLANCHECK FEE ' ! I cerifythat lnthe performaneo.fthe wodfmwhich thlspermitis mooLl shall SEWER-SANITAR STOR PT. 14 not employ any person In any manner so as m became subject to The Workers'Centauri; - ENERGY FE � ,Z vmiou Laws.f Califomia.Date - - - ro `UCi z O Applicant - � GRADING FEE llAANOTICE TO APPLICANT:If, ft ..king this Ce i f ale of Exemption,you shouldeWAWT.ER,SYSTEMIC' - E~ bete rte subject m the Worker C ma n:m p of the Lahr Code you crest' E - forthwith comply with s -h p this permit shall be deemed revoked . .R s s l Q s, z CONSTRUCTION LENDING AGENCY S GNT B. .FT - ' PAID `" " l..) 0 1 haretiyifion that,theres a construction lending agency for the performance of ^Dam Rceipt isthe wnrkfnr which this permit is issued(Sec.3797.Civ.C.) O Lenders Name �1 TOTAL: V Lenders Addm%s - - _ TOTAL: ' 4 _ I errfy th t 1 by ad this application' d state that theabove s BUILDING PEE�v ` .a lA comst l g t .ply with II city dcounty m' d tone 1 refining QTY. MECHANICAL PERMIT PEE 0 building n.truf .and hereby authorizeepresentatives of thiscity to enter upon the SEISMIC FEE .,, w-T above-mentioned property for inspection purposes. PERMIT ISSUANCE. I i \. (We)agron reserve,Indemnify mid keep homeless the City of Coastline against ELECTRIC PEE liabiltesjudg ems,cost d expenses which mnyn any ways rue against said City pLTF.R ORADD TO MECH• Rt, in comoompnceof The gr i g fdakpermlt PLIIMNINGFEE APPLIC T UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 CFM) - s SOURCE EGULA IONS. 'MECHANICAL PEEdf AIR HANDLING UNIT(OVER IO,II(NI CFM) CONSTRUCTION TAX, Sig a App N nmpaactor ! - +' X DW EXHAUST HOOD(W/DUCT) sA HAZARDOUS MATERIALS DISCIASURB' HOUSING MITIGATION FEE Will the applicant or futurebdliding occupant store or handle hazardous material BEATINGO UNIT(TO 100.00(1 BTU) ' a%defined by the Copeman_Municipal Code,Chapter 9.12,and the[]earth and Safmy Code,Section 25532(.7? y' HEATING UNIT(OVER 100,000 BTU)' - ❑Yes E]No PAID VENTILATION FAN(SINGLE RESID) Date Receipt W' "Will the applies.,or firm,,building occupant me equipment m devises which emit hazard...air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP(SHP OR,100,0011 BTU) - Dismict" - .. - " TOTAL Yes ❑No - BOIL ER_CGMP(OVER 100,000 BTU) have read the ha rd u.materials under Chapter 6,95 ftheCli- t-' AIR CONDITIONER 9 P ISSUANCE DATE fnmia'Health&Safely Cole,Sections 25505,25533 end 25534.I understand that if the i NEW RESIDENTIAL MECH. SQ.Fr. building does not currently have a tenant,that it is my responsibility,to notify the occupant, of the requitemems which must be met prior to issuance"is Ceribcam of Occupancy. Owner er auNonzed agrat -Date TOTAL: ISSUED BY. OFFICE_, .