S 1426 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
;BUILDING
Y OF CUIXH:RTINO HH11,nI'N -I?LI?C'IRIC\L P[1�R`pI1'I NO.
DIVISION APPLICATION/PERMIT
rl.urvunrvc-nntcunNlc^I' V 1426
nuu,Dlar,rxnncr u)rsrDlcn'rury
DING ADDRESS: SANI'TARYNO. APPLICAf10N SUHMITTALDA'II:
0 NIRSNAME PIIONf:: CONTRACTOR'S NAME: LIC NO: NIC Ct1NTROLW
L`W RaaA0r-w t cAtoc 3w-at ❑ /{y/`J�1Jj
kQfIJ'E.17l1ENGINEEW LIC Nb AUDRE S:
ED TFIN�C� L9 Ifo/
CONTACT: / PIRTNE BUILDING PiiRMll'INTO
4 0-1 l�Y�I�92,- tib ❑ Consultant Fees Paid by Applicant(initial) yI lltl +Lt I:Cr P1 Ubfi MECH
LICENSED CON TRAC1(It'Is DECLARATION QTY. ELECTRIC PERMIT FFE JOA DESCRIPTION
1 hereby affirm that 1 sen licensed under provision of Chapter 9(commatuang
o�z xithSection7000)ofDivision3afineKusin,w.nJProfession,Codeundinylicense11 RFSIDFNTIAL'
W Q O PERNI1T ISSUANCE
CSN full In",and cif"'. ❑"DWI. CKI'ICI{EN REMODEL
U Licen>e Class Lif.p
a U APPLIANCES-RESIDENTIAL HTION E3 PLUMBING RIS PIPE
Ua, Cnura,o r
Huh ARCHITECTS DECLARATION PANEIS TLUNI'T ❑STRUCI'HRAMOUIIICA'1'ION
y Z 1 unJersland my plum,loll be used us Poblkncow,
OZ4- UP 10100AMPS ❑IN'I'1iRIOR CCHIMNEY REPAIR
F-I:'IOiI Liceewd P-lesxlonal 201-1000AMI'S IMPROVEMENT SWIMMING POOIS
a OWNER-I1111LpER DECLARATION
C x Q 1 hemby affirm that I am caempl Gose)he Connacmty license Law lin Ibe OVER HXXI AMPS BATH REMODEIIRIiI'AIR ❑Dlini0l.l'UON
x aU IiJlowing Tcasan.(Secilon703LS.Imsinus,and l'mfusdon,Cade:Anycity orcounlY SIGNS ItLEG WCAI. ❑OfIIEk
W 3 a ya which requires a permit to<no,nn,,mar,irnmese.dcmalbh,or repair any nmcmre
I�'LL'OJ priors ts"ItimCC.also requiresthe up,hun.1I Itnail filc SPECIAL CIRCIII GMISC.
� �.� that) I' Ip t the p ftr C 1 1 1' '(Claprtr9
[rC tY aC) leomuu Rcmgwth Scakm 7(XXI)nI U'vidmt 3ohhc unsure,,and Inti wi n,Calc):. I'EMR MI TER OR POLK INS"C COMMERCIAL
t KO C thin he is exempt fin,o fraroand the basis fur the alleged ro,nmuion Any violin of C NEW IRAGIAUUI'fION ❑DEMOLITION
e u by applicant fin a Permit wspoell'lie applicant it)a civil peruli f POWER DEVICis
Section IOJISr any Yo IMPROVEMENT
not
[3 1:001)SERVICE
" not more man EVC hundred dollar M(S).
SQI,u,owner of lM1e rl SWI.MMINGPOOLLLEC'TRIC IMPROVEMENT
C pmPe y,onryemntended withk,red usmeir vee cvmpersatiao' ❑OI'lilik
r. will Aothcwou1 C...e:*Meand the tum isnmimcndcd oral do is ow...(Svc.9 awasr4. u:,oe
63 m and I'rnlcssions Coda'Ihc Cnnvanor'x License Law J.ws nm ak hn to an owner of OUT-FTS-SWITCHES
propcnY who builds onmproves tbcrenn.:mr who Jrcs tech workmed or of mnmgb
his own enhpinyees,pnrvldeJ mm nosh impruvemm�L aro no imendeJ or offered for NEW RP_SIDIN'TIAI.I?LIiCfH SQ PI'.
ala If.however,the building or impmrennm ivnld within tine year of cnmple ion,the SQ.lel'.FLOOR AREA S/SQ.ler
ow.u,,milck,will hove the hurdenofpoMng that he did not build or lntanve for put- Cob
P',casulc). IFS/
I..,o tR,of the properly am exclusively contracting with licensed ctimnmmca n,
construct the pmjsat(Sec.](WL I{usiress and Profession.Cala:)ine Contmetor's l-
c cl,:tw dates not apply to a mown,olp...pery who huildcnrlmprovex thc.emn,unit QTY. PLUMBING PERMIT FEE [4O6
who mtmcrr knsaeh projces with acentfa,un,)liea-dpur`uuu,o the Commemrs
Licenc Law. PERM T -SU NICE
❑ lam ex t nd Sac. ,II&I'Chulhly.er"m
ALTIi -D IN&VENT-WATIiR(I?A) �t(A v 1rATIlIN
Own lam 0
WORKERS COM111'ENSATI(1N DIiC1.AHAlION BAC fled 1'ROTE DEVICE hereby affirm under penalty of perjury ane of the following dedumtion: 1
❑ Ihove and.01uniimuina Ccrtitka,e til Co Islam l—&-in,,onet Worker,Campers- DRAINS-F. OOP A.COND STORIES TYPE CONS'ISIX ]ON
ration,o,provided for by Section 37(X)of the labor Code,far the pvA urnom"or
work for which this permit is i,wcd. FIXTURES-PER1'RA
C I have and will maintain Worker's Compensation Insurance,as required by Section
S]Wofthe labor Cale forthe Pefformarecof the work for which this Permih is Issued. GAS-EA.SYSTEM- C.J GLEES ()Cc GROUP APN
My Wa ker's Cuna,en,ation Insurance carrier and Policy number arc:
Camcr. Policy No.: GAS-GA.SYSTEM-OVER CO
CFO IFICAIIT OF HxEMi7I(1N FROM WORKERS CREASIJINDUSI'B,WAS Ii IN FERCEPTOR
COMPENSATION INSURANCE EI11L1 D ISION FEES
IBit,sction need not re.omplemd ftn,lic it is turanc hundred elapses l8l Wl GREASE'I KAI'
nrlus.l 1'LANCIII!CK IyiIE
Ic.Rfynnd in the pabummn,,mthe w'ark forwhicM1 lbispcnnn is issued,ishan SEWER-SANITARY-STORM EA.2W FI'.
not an"I"ary Pcnun in;I,mnnncr o0-m bttlmlc suhlecl to the Worters'Compen- ISI?RGVllili
Z nation Luwsof CARmia.Dae WA'IIER 14 El 13R WNI'NIIIiLECTR GRADING FI::
C)
O Applirm
NOTICE TO APPLICANT IL after making Iris Certificate of Exemption.you should WA'IEH tiYSI"EM/1 BEATING SOUS FEE
become Xobject to the Workers Compermtimt provision,of(Ise I,uMr Cud,you must
forthwith eonmly with such pmvi,ions or this pcmti(shall be deemed invoked. WATER SERVICE
QI'NU
CONSTREIC'I'ION LENDIN .AGENCY NEW RESIDENTIAL I DMB. SQ.Icr Receipt#
U 0 I hereby aura that hem is a construction[ending agency for are performance til'
the work lin which thi,permit is issued(Sec,3097 Co.C) TO AI.:
Q Lender',Name T( T .:
C) U I.ender'a AJdnxs 111111.1 Il',
t]. 1 certify that I have nad Ibis applicaunn surd Mute that the above info.mmion is
Ern mrca.l agnemcnmply wise allcirymW county nrdiwnma wd,mm l�wsnlatinF(o QTY. MECI IANICAL PERM IT FEE SKIS 'F
U btuldingum,lmclmn,and hcrcbY ambon/e rcp.mcntmivo til thin city mater upset the {
above-mentioned property for inspection purrysm,. PERMIT ISSUANCE t �}
(We)a' to nava.indcmnil Turd kcc hunts,,Inc Cit f Cu I ainv ELIiC'1 1_14Yi
1 brcc y a P cc per inn ag
liubilitic,.IudpnhenN',caaa and expenses whiuh muY in unY way assns against aid Ciq' MITER OR AOU'I"O hf[CII. YLllhfl NO FEE
in consequence of the granting of this Permit.
APPLICANT UNOERS'rANOS AND WII.I,COMPLY WITH At.[.NON-POINT' AIH HANDLING UNIT(To 10.000 CFM) MECH, 'AL FI!E
SOURCE.REGULATIONS.
AIH HANDLING DNIT(DVER IQIXp CPM) )NCV'I' ,CI NTA%
a
Signumnof Applican0Comm,r Wmc EXHAUST HOOD(W)DUCT) HOUSING (' TION FEE,
HAZARDOUS MATERIALS DISCLOSURE
Will thcapplbam or fumrebuilding necupaut worcor handle miadous maleriul HIEATING UNIT OD IW,((X)BTU)
u,derineat by me Cu", Munici Pal Cala.Chapter 9.12,and the Health and Safety HITATING UNIT(OVER I(X).(XX)NTIJ)
Code,Section 25532(a)'! 1 BAN)
Yes F7 No PAID,c Xt
❑ VEN'I[LA'1'ION ITNISINGLIE RESIU) J1Dam Rcmipt#
Willtheapplicant i 1'umrc huiWing by the sly Area
Air QuuTat er Management
BOILER-COMP(3HP OR 11X1.00()BTU) V
�.mhil hamrJous air cumxininuna its JdincJ by IM Hay Ana Air Quality Managemcm '1 t;
Dmiri [? RUETER-COMP(OVER I W.( TU)
' ❑Ver IT]No KKIR
AIR CONDITIONER ISSUANCE,DAPI:
I have read th<huamdnm nwmriub myuinmenb under Chupwr 6.95 of ma Cull-
li,miu Ileallh&S,R ly fide,Section,25505,25533 and 25534.1 undcotund that flak, SUE N BESIDES I LM.MECH. SQ.FI'.
does
building donot sureto nosily d e occly have a tenant,that it is my mponibilhy upam �S
of tire.aryinment,venal, .,(be mel pnu In issuance ofa Cenlficmu of(keupuney. r1 'T-
Owner or authuriaed agent Uum O LY ISSUED BY: 3�2~ `
OFFICE