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S 2502 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY ' CITY OF CUPF.RTINO BUILDING HLECFRICAL PERMITNO. nUD.DINODIVISION APPLICATION/PERMIT PLUMBING•MECHANICAL 5 C0 BIIILIIING j' )JF.CT IDENTIFICATION Q O BUILDING ADDRESS: 2 ' -/f- I C'g SANITARY NO, APPLICATION SUBMITTAL HATE C ER'S NAME: PHONE C NT Cf0 S NAME: LIC NO: ARsan� S'�Lvt4Ti�ne,� 73p-S33o �culS -S y5g7o NIC Q) CONTROIA C ITECI'/BNGI C'No A RISS' 71 y OL wy f ❑ ) U b 71 u.✓� �N Y/ice Ce 9SToS 4 I coNTnc'l': (fbG PHONE: EUILDINC PERM IT INFO AP_swu 77703x- r33o ❑ Consultant Foes Paid by Applicant(initial) BLDG PLUMB H z� LNr LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT FEE I hereby afrnm mm 1 am licensed ander provisions of chapter 9leommencing JOB DESCRIPTION OCz with Section]IKKnaf iivision3.fthe Bminesa and professions Cale,and my licenw is RESIDENTIAL Irl O PERMIT ISSUANCE in full parental effet A -114 4104, ❑SFDWL ❑KITCHEN REMODEL CUU Lmense CP s 1� Li[ Q U r.V� C'"�' c APPLIANCES RESIDENTIAL DUITION C1 PLUMBING RIi-PIPE Fz41 Date �-1 Commour rAQ1 Tom- ❑MULTI-UNIT ❑STRUCTURAL ARCHITECT'S DECLARATION ';Ion PANELS MODIFICATION OZ'-Z J wderxund m plans hull C used as bite lice ds tQ ez/n" (_�fO i+ / UPTO H1AMPS 2. Z D C1 INTERIOR El CHIMNEY POOLS Qg„F]ul scS Profess_al ]OI-IIIfk1AMPs IMPROVEMENT ElDEMOLINGPOOIS C+�W; OWNERt excarIF.RUEthe Cia ION OVER Hills)AMPS OBATH REMODEI/REPAIR El DEMOLITION C C Q 1 hereby affmn that 1 am exempt from the Commctnr's e:A License Law for the 3 0 F which a )Sec f i 7031.5.Business and sae,denons Code:Any city nr roomy SIGNS IiLGCI'RICAI. �DTNF,R. on whichit....stations a permit oc consumer,alter,improve,h twornh,or repair any swemre Fu'Oi but he licenddparro.reyaircs provisionmo ofllw ontracmiLm0cust,Law(Chpter9 SPECIAL CIRCUIT/MISC. ,SO ' y that he is licensed punuunnnthe provisions nfthe Contractorsndpi-oe,jor,Capter9 �ap0 :commencing with Section?000)of Division 3 of the Business and Aofexsion.Cale)or TF.MI'.METER OR PO COMMERCIAL: 6 y c C that he in exempt therefrom and the basis for the alleged exemption Any violation of ❑NEW BLDG/ADDITION ❑DIiMOLI'f10N X m6• Section 7031.5 by any applicant for a permit andi"Is Hie applicant o civil pnultY of POWER DEV) S ❑'TENANT ❑FOOD SERVICE ��� not more than l ivc hundred dollars($500). IMPROVEMENT =Q ❑Mux owner of the pnspcny,nrmycmploycexwith wagesteLheirsolecnmpensmion, SWIMMING E F willdo he wod..und thestrucwrc is not intended aaffered for sale(Sec.]1114.Business ❑OTHER Bal J:m Ind Prnfer.siam Care:*Me Contractors License Law does nm apply m an owner of GIITLITS-SWITCHES-FIXT O I,3^ property who builds or improves thereon,and who docs such work himself or through his own employees,provided that such imprnvanenu are not intended or offered for NEW RFSIDEN'I IAL ELECfR SQ Fr. sale.IL how,verds,building or improvenrem is xold within one year ofena lmiau the SQ.FT.FLOOR AREA S/t pp owner-huilder will have the burden of proving that he did not build(ir improve far per- of ante.). �•I� 1,as oproperty,ton of the propeam exclusively Cantmaing with licensed contra,... p se to T T T /...��© consva[t tba project(Sec.]814,futures and Not..in.,Cale:l The Contractor,Li- Vy // nsc 1.aw doe.nm npplyman owner of property who builds nr improves thereon.and QTY. PLUMBING PERMIT FEE who contracr.lm such projects with a contrdemds)licensed liu ummann the Contractor's License Isw. PERMITISSUANCE ❑Ian e.empt under Sea ,B&PCfor Nis mason ALTER-DRAIN&VENT-WATER(EAI VALUATION Owner Date w WORKERS COMPENSATION DECLARATION HACK FLOW PROT:CT.DEVICE / _ /(1 CD hereby. umn under penalty of perjury one of the folding federation, ��P CJ ❑I haveand will maintain aCenificumof Convent to self-in.vure for Worker's Cnmpen- DRAINS-FLOOR.ROOK AR G.COND. STORIES TYPP.COpSTR 1CT10N ratan,as provided far by Section J]W of rhe Im abCode,ter IAe,cr,amance of the Q VJ work fm which this permit is issued. FIXTURES-PER TRAP LC El 1 have and will maintain Workers Compensation Insurance,as required by Station 37110of the Labor Code,fon he perforromecofthe work far which this permit is I....d, GAS-IiA.SYSTEM-1 INC.4 OUTLETS OCC GROUP APN My Workers Compensation Inaanmcc e.merand Policy nun1w,rare: Cartier. Policy No.: GAS-IiA SYSTEhI-OVF.R4(GA) CHR'IIPICAI'E OF IiXEMPI'ION FROM WORKERS' 1'LANCHECK I:EE BQ GItEASFlIND115TRL WASTf:INTENCEPTUR COMPENSATION INSURANCE BUILDING DIVISION FIEFS Is'less.) (Thin section aced notC completed ifthc pcount is lot one hundmildollao($100) GREASETRAI' 0 � locolf,minindbaN mininceoft i workfnuwhichI i.vperniti.iswed,ishull SEWER-SANITARY-STORM EA.NX)FT, nm employ any pc any ma. an .me �j do Woder�C.'nper- / IS ER .E O© z sationlaws of Culi Dam JI/C WATER HEATER W/VENI'?LFCB Q zO Applicant G A 1 FEE (A NOf&TO AP' :If of 11 ing this Ccy 'f F;xcmpunn, told WATER SYSI'EMOREATING become subject to the Worker'. ompcnsmion Dia it of rhe Labor Code.you must ( 'F.Is forthwith comply with such provisions or du� n' shall hedeemed revoked WATER SERVICE Q as CONSTRUCTION LENDING AGENCY NEW RFSIDIiN'TIAh PLMB. SQ.IT. P D Dote Rettiptk UQ Ifofamily.Inchrhi thatthere islad(Set.ionlendin%agency for the performance of {T+ F Leaders forwhich his permit is issued(Set.3097,Cie CJ '101 : at U Lender's Add O {ZI Icnticrs AJdrcry L' 1 eerilythin I have mail(his application Indxme Lha,the abavc ofomuti-Is BI DING FF:E rFs (aO Correct.I agree mcomply with all city and county ordinances and state laws relaxins to QTY. MECHANICAL PERMIT FEE O L) a huiltling cnnzWclinn,and hereby nuth.rizc rcprcvemmivex nrthis city m enle,.,.n the SEISMIC"M above mentioned progeny for inspetiun purposes. P,RMI'T ISSUANCEY 8, (We)agree to one,indemnify and keep harmless the City of Culanion against 1 ELECT IIiE Z .Q�C1 liabilities,judgments,costs and expatriates which,.,in any way ucemexgainst,wiAChy ALTER OR ADD TO M ECK. Z� PLl BING FEIi to osoqu,r,r of the greming of this Nount. API'I.ICANI'11NDERSTANDS AND W .4-IMPLY WITH AIA.NON-POINT AIR HANDLING UNI'!(To Ig0(M)CFM) CI ICALFT-E O SOUItCF I,A1'IONS.� AIR HANDLING UNI'I'(OVER 10,000 CFM) O. RUCTION TAX I cure A"Hcan contact Date EXHAUST 11001)(W/DUCT) H SING MITIGATION FEE HAZARDOUS MATEIIIALS DISCLOSURE. Will Lhaapplicantar future buildingneeupamsmrcor handle M1azard.n.material HEATING UNIT(10 10(1.000 BTU) as defined by the Caperton Mmicipal Cale,Chapter 9.12,and(be Health and Safety Coda Station 25532(.1? HEATING UNIT(OVER❑q,INXI IiTII) E3 Yes No VENTILATION PAN(SINGLE RESID) )'AID - Dum Rec<ipr M Will the uppllenm o future building nactipam use equipment nu devices which BOIL17R-COMP QHP OR 103,001 BTU) eine hazardous air comaminams as ddnul by the Buy Arca Air Quality Management District:' BOILER-COMP(OVER 100,0ID BTU) C)Yes No Ibmemadthchaz n maIcrialsrt AIR CONDITIONER ISSUANCE:DATE pair renis ander Chapter fl95 of the Culi- fomiaHealth&Safety Me Secdonn25 I5. 53 and255YI 1 undmomal that if he NEW RESIDENTIAL MECH. SQ.14. O budding does not currently haveumnanht s y responxihilitymnailytheocct,ani elm orthercs which rte t exp- "o of ofa Ceni 41am Occu u Own rah izW eSem Date TOT L: ( ISSUED BY: OFFICE