S 2658 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE ALL POINT PEN ONLY
CITY ON CUPER'FINO BUILDING-ELECTRICAL PERMrr NO.
ItUI1.DING DIVISION APPLICATION/PERMIT rB.unuurvr,-nu!rnnrvlcnL S 2658
BUILDING Plea cH I'IDRN'CIFiCA'r[ON
Ot11LDINGADDRESS SAN( ARVNO. APPLICATION SIIBMI'1'I'N,DAI'1i
�q P - ccs �-r o r, -z o
ER'SF P�IONIi' CON'rltACfOR'S VAMP' N
SIC CONTROL#
dClll'I 17C EFNGINEER: LIC NO: ADDRESS_( D ❑
CONTACT': PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECO
0 L-10 bl ❑ ❑ [� ❑
LICHISS1?D CONTIiACIOR'S DECLARATION QTY. FLECPRIC PERMIT FEE
1 nanny anina Una 1 m»Iieea"I and,,"o"roons of chapmi e(eannendng JOB DESCRIPTION
aZ w�l,scelon 700o)al'DhiuLm3A Inc Budnessand P al'faslI sCnde' ...y license is
RESIDENTIAL
WOO PI?It MIT'ISSUANCE
H1y-r in full lnrce in,l fee ❑SFDWI. ❑KI'I'CHHN RFMODEL
<UU IJCclnc Claay lac# APPLIANCES-IIHS11OFNI IAL ❑ADDITION ❑PLHMIING RE-PIP(?
ZWW Ham Cainracao 'I
ARCIII'l1?CT'S DECLARAI'I ON ❑MULTI-UNIT ❑STRUCTURAL
zOy- lundurswnd ony pbmrs.droll he usul es puM1lio rrsonk PANELS MODIFICATION
OZ � UI'T02tlt1 AMPS INTERIOR ❑CIIIMNEV REPAIRQ.- m licensed Pnrcas?uolaI 201-1000AMPg IMPRGVEML'N'IE]SWIMMING POOLS
zw,% OWNER-RIJILDER DCCIARCI'ION pyUR IUfq AMPS ❑BAlll kleMODI?IARFiPAIIt ❑DI3M01.1TION
GOWV Ill hy,Il dal Ill GnnI I wlot'Nc El THER
WW'6 loll 6 Section 703 1,5,II d I .l C 1 A) `ty oeY SIGNS CI LCfRICAL .f .J
rwH wb' n II '1 1I n f� clearsay a cn'C ���5_��Y �'O
y
,H.�06 p-n ( I 'I. I ,Ill nPl II 11 I 11 b I Pmncn SPhCIAI,CIRCUI'fIM ISG
gN� fl alar tid puna alt a aheol 11fall Connor's Lc xc Law Call,"c19 �L/V yl�-'$
pWQC, COMMERRR�IAL:
(can rearing wall Sem ]0(11111In l fl B sacs, dl f.! sCode)or '1'I:M n M H'fER OR POLE I NST. -
y am
[III l - ..I hocroon art one bala,ka ll,.alloCedur Pa 1y 'iolall,of ❑NEW BIDCIADDI'I'ION [-1 DEMOLITION
YYYYYY111711 kk.• Scof 7031.5 by any Ina aor It"onalit' hj ',.tire"Po as I renally eI POWER DEVICES.
TaA anal t,eve handreldoB. N($500). ❑'f IMPROVEMENT ❑FOODSERVICE
H Z 01THERVIiN11;N1
Q ❑ Lav nwnenrl thepropeny,mmYeuployceswiN wagenuslheirsnleunnponsmmn, SWIMMING POOL EhCC'I'RIC ❑O'I'IiliR
onlaid A-
]
IdraCom saaae ll - 1'f If (S Pt4R .
W m roil I: C1:'I hrc Gntr sua,LicenseI 1 a sillilyt an o'nalrnl OI1'I'LHTS-SWI'rCIIBS-1I
M3" Tarp aY II' poe,0 1 who thae, b kI-all' thrsbb
at,Lose con,loy, I ),,,led than ,.IIIpraises at,, I I I I - II 'cit foo NCW RESIDES I'IME EI.:c'I' SQ
5.1e ln,rwrvr.n rna ld y 'npnvr,e,l s,old aht rywrn fns 111 fa,Ibe RQ,Pr.Fux)R Hann SrsQ.Fr.
n m Imiker will hove the hnNen of proving that bcdid noI hoild or linprovc Son par-
al
poseofsWc.).
❑ I,ns(twoeroflhe pruperl.all nxdusivsly contracting will licensed conlrri o s to
sn..rom shop Jura(So,,7044.Rusiress and Pn ass Das CodC:)I le Conlrc oo N Ll-
cLave dne nolapply m III,owilerel pnlwrtywhit huild-,ioyne<cs lhcrcan,and QTY. PLIIMBINC PERMIT :E
who rnnlnmstor suehp Jens wish acnevdnLos)hmnNeJ nnrsuunl mlbu GonEuora^s
License law. PERM I ISSUANCE
�] Ian,exennl ander Su:. .B A P C Inn 11,1,felon
AD 131Z DRAIN Ar VHIS'I' WA'IT.� ( A) -� VALUATION
Dan, _
WORKER'S(ONIIINSAI'ION OECI 1RNFION BACK FLOW PROTLC'I DMC if
I brief,Loll...I I de,-p "1Y fP I Y 1 the bellowhe'doch
� Ibveand will aninnairia CevfcaoofConsent n selfiasrc In Worker's Coal)- DRAINS ELOOR,NOOI ARE 'OND.A P S1OI2111S TYPE CONS'I RUCTION
sal 1,,us provided Err by Seclon 3700or the Labor Cn It fur the pcfrormnncc III'he
k lot hid,d':peril I. FIXIURFS-PER TRAP
VIIIt N 'k :( P f I - cr. prcdbyS edion
NY Wur " a �- GASIA.SYS'IiMINICI.A)'I-
T-S3700lJhr LuhnrCodr,lo ahcperlTn <udthr wed for wErl❑hinPnls sstu �
GAS
)CC. 11011MIN
A Pio
Policy No. NSM-
C1rR
CEK
eN11HlON PROM VVOIIKP:12$'
CObII I?NSAI'ION INSURANCE GIEASf?IINDUS'I'121,WASTE IN'PERCEP'rOR
BU11,11IN0 DIVISION PEES
(I hlssecaian need nal hccovpleed ifahcpe...at',,l it.Une hundreddollwos($100) GREASI?'rRAI'
of loss) PLANCIIECK PEE
I reodYdml in ah,,arfonnaneof Ila—aklr-Ind,ahlspermt is awed,Ishrll SEWER-SANITARY-STORM I?A.9(N)Ff.
pmt ornnloynny 0e11an In any at I sees to accome subject m lie Workers'CnTpen- ENERGY B EG
oz Natiun Law,of Cul'dm'nia.Here p WA117R SYS' HRWNI?NTIELEC'I'It
G Q Applicant WATT?R IIF,A GRADING PEE
y NG[ICE 10 APIIICANI It,afI 'k bill C 'f aro IL i y Nhn&1 1'ISTEl3.A'CIN('.
1-'IH hce hlIt Ihek :C I I 1 well I'll -C y r naa SOILS FIT�+ � forthwith rornply with such nos',i Carr-this punio shall be dcorred evoked. WA 1 17 SERVICE
aQ CONSTRUCT ION LENDING AGENCY NEW RIESIDEN'I IAL IILMII. SQ.IT, PAID U
Q z Ilhy al Erin lhat farm E acanannlon lending agency list the perfannaaceaf Dom caipl#
U O mm
all wark for which his peon is issued(ree.3010,civ,C.)
fennels Naine TornL
Q U Lenders Addor, TOTAL:
a1 serif,(hal I have read this HlI licabn a nand an Ihal Iho ubovo afunnvlion ie BUILDING *I?E
F rn correct I EIS,tocon,ply will,all city Load coolly vI.irnnocs and s,Eric law"caningm QTY, MECHANICAL PERM I FLFE
U Z buil di Loy cnmwcGun,andhollb,selloff it,I opt cncnl el i ves of lois c ry lar crier upon the SEISMICFEE
ahmc-once bard properly for Iaspcdi(in P lleells. PERM(l'ISSUANCii
OV,,) s
J agree Iu Live,ind,l nily end k«n henals,Ihu Cry of Cnpeaina ngaiust ELECTRIC FBR
Iiabliaics.ledgn,cnl.cva,andcapmecs whmla only inany way acrnre ngaiml treat City AI BIN OR ADO'1'0 MECH.
msegnenmo aegnulllog of lads penult.n, WISE
APPLICANT ADP NUS AND .f MPLY WITH AL1,NON-POINT AIR HANDLING UNI'1'('10 a0l RECITM) II
SOU 'IT MECANIICAI. EE
3_ AIR IIANDLING U N I'I'(OV HR 10,00)CFM) CON S I RUC I ION TAX
igneuuc nfAPl unVCa .cmr Dam EXIIAUS'I'l OODW/DUCI) HOUSINGMITIGAIE1014 FEB?
HAZARDOUS MATERIALS DISCLOSURE
Will tile all all rulem hnildingowupunts(mc or handle heranluuI nlar"'d HEATING UNI T'('10 I Nlool B'fH)
"dc5al by abc Cupcnino Men sinal Code,Chanter 9.12,red We IIcaid,(rod SnElly
Code,Set 25532(alf HIHA'IAN .fSH(OVER RaIll1)ICI U)
E]Yr, �So
VCN'l11 AfIGN FAN(SINGIERIISID) PAID
Daae Receipt#
Will d pplLe f t - ranking lc Ia awry p 1 devices which
IIOILEIR COMP(3HPOR IOEOW B'I'U)
n h � 1 - fume a dlby(1 Bay Area A'Q ItyM lube neral .1t
Dia cf.
❑Yes No HOI EBR-CGMP(GVBR I01),000IfrU)
I not,rend(he hamnlour arecrials a is ander Chapter 695 Lor the Calm AIR CONDITIONER ISSUANCE DATE
yuiremm� p
bell f'IIh&Sfl < I S91111�
25511 J 5534,1and-landhtit ON NEW RI?SIDEN'PIAI,MIiCIL SQ,b
build lad a tly . .II(YI If)II ,' p'nal ��off Heals wti a e ecofIC a'1 IeofOCC panty.
Owncl'all m1lhofiuJ Igen Dule TOTAL: 15$I]I?D BY:
OFFICE