99120007 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OP C+JPERTINO BUILDING-R"LECTRICA L �/1 :RMIT N(1.
POII.DINC DIVISION APPWCATIONIPERMIT PLUIVIR INC NIFIC I iANIG\L 50001
BUILDING PROJECT IDENTIFIGTION
HUILDING ADDRESS: SANITARY NO. APPLICATION SURVITTAL GATT
O NCRS NAME: 4ONE � rJ CONTRACTORS NAME: UC NO'. �r�^ 2--9NIC CONIRGLX
RCHIIY: AiNG1NFF.W o: _LIC NA ROSS:al
❑
ra U I�
CONTACT: PHONE C' BUILDING PERMIT INFO
Consultant Fcea Paid by Applicant(Initial) BLDG ELECT PLUMB N1ECH
510 .50 ❑ ❑ ❑1 ❑
LICENSED CONURACHIR;S DECLARATIONQTY ELECTRIC PERMIT FEE
T hacby elBtm Nas t I a1i¢nsd utdcr prwisions of One for 9 B olmmrcin¢ JOB DESCRIPTION
MZZ wiN sawnxro7nf ondsim ,.f Ne Busitc.uand�Pm/fe.uoru cwe.em myliana n RESIDENTIAL:
WW2 - L 7 I'I!HMITISSUANCL
C [[-� in full fmvc nrN ce'ccr •1 �1 L DC7 ❑SPDN'h KrfCi1BN RES10DIil.
FF6--VU Imb _d-N Le'X APPI,IANCI!S-RESIDENTIAL ❑AUDffION ❑PLUMBING RE-PIPE
ma_a Iwe T/i '( llaWm
RCIIITECTS DECLARATION ❑FIULTI-UNIT ❑SIRUCfURAL
ZO 3 i'ANT:LS MOUIIICATION
1 unJcmm�l my plain aM1all M uscJ n.r public mmrJ�
OZ�O Dp TG 2g1AMP5 ' El INTERIOR ❑CHIN1NIiY REPAIR
W Licm¢d l4ufusioru! 201-10WAMPS IMPROVF%IENT SWIMMING POOLS
OWNER-HUILDER DECLARATION
C4 C a d 1 Mmny¢(Tont that 1 am exempt ionto nhc CentrJcmrtr Liccnm Law for the
c OVI'R I(0)AMPS ❑BATH REMODELI lll'AIR 0 DEMOI.I'I'[ON
y O C U folkwing ric.,(Section 7031.5,Bust.,au!Prefexdonm
s Ck:Any city u c.my SIGNS ELECTRICAL ❑
.'I ch call a permit to emmtun, It,.improve,demolish,an-1111m atty urucmre
F-�Cn prim to its i.aearce,um crammer the applicant fu such pennom f1easogmx1 stmemem SPECIAL CIRCUITIM ISC.
�ym putsuam pmvlsiomn pier,
NmaoxnecemW Ito Na (the Gmtni.sniocmeiumins w Y
1x00 Bad list,cowiNSMion]Oro)of Division J tit Ne Btnitl¢s erW 1'm(Anyli Cute)of TIiN1E h1E1'I:N OR Ih1.E INST. `
a d WI k is cxempn therefrom artJ nk hasis for ne ule¢cd uemp(un.Any viafaniao of ❑NEW BLIK✓AUUfUON ❑DIiMO1.ITION
Scam 911115 by nnyupphcam l or a permit subjects the op,besnl m acivil penally,.( MWER DEVICES doom ❑'fENAMi ❑1'001)SERVICE
nI tmre Than five hutlsnd dnllus ISNXII.
LSp ❑ I.0 owns ofntr pmpen>,mmY mnW J�with wegcsu Noir wk comprmaim. S IMPROVENIFM
yy will do the work,utd Ne cavcnte is not intneld c-Rend fm sue(Sic 7 OTHER
a a am Tk,.rca.hm.CoihT me Cnmrit"or'.s Lcen.m Lew does a.,apply m e f
prtspctty who build,or imp rnvca tMrmo,and who tkta wch wuk himalf
his mor empin cs, mvicki then och impmrclnalns x not imcndei or t NEW RESID- S
sale.IL bmaer,not nuildinB or int,motmerm is wkl Mihirimc yemofeomp coon.Nc SQ.FT.FLOOR AREA SAO,ITT.
tcr-hulkkr w11 he-the nonlen of proving than he del not huilil a improve for p
pore.of role).
1,u owner of Nc pre{eny,em eacllssis'ely conancting wiN licensrd mxrrcwn
m.siren the"Ii(Sec.]OW.Hmircxs aha Pimicoverns Cork:)The Contmcmis 1
a Law does not apply man owner of pnMeny who nuihls or improve tM nn,andllip B E
whe c Law do Ionsuchpty too wilnammmetn(s)!noosed orrolto Ne Cm
license law. N
❑ I sm exempt esdn See ,B&PC for nhix
AMU-DRAIN&VENT-WA'T'ER(EA) VALUATION
Owner ULC
WORKER'S COMPENSATION DECLARATION HACK FLOW PROTECT.DEV IC1;
I hereby affirm nrdite Mnally of perjury enc of the following dclmniom�.
�] I have and wi 11 amormlaaCenificatc of C—ae,m¢I4'moin,Gid Wads,-Ctntpen- DRAINS-FLOOR,ROOF.AREA.CON STORIES 'rYPECONSfRUCf10
smirk,es pmvfm by Section B"I00 M the 1 Conde,f«ce,Nc perlerrnvRc M IM
work for winch TMs pitano,is isucd. El)fITlRFS-PER TRAI'
I Mvc La will rmi.for Wukcra Compcmmi,.n A letImurwhich
m«4uirnl by Section
l)IXIn(Ne Ltlxx Cola.for mc per(mtumx of Ne worA lir which Niape.mit is i.aucd. GAS-EA.SYSTEM-I INC.JOUII.FTS ()CC.GNOUP Z�AYN /
Cs Workefs Costpctwtioo Immure cortinand Policy wmnc sae: A T
Cadcc Pdiry No.: GAS-EA.S1:SIEM-OVER J IEA) fJ
CEk'19FICATE OF IXEMPTION FROM WORKIIRS'
COMPENSATION INSURANCE GREASE/INDUSTRL WASTE IN'I ERCEMOR BUILDING DIVISION FEES
(musenion trod oa becrxnpinM ifthe Formal is forone hurdtd dollus(SIM) GRP\SETRAP
u Try.) PIANCHECK FEE
I cenify than in the pmfomaace o(Ilie work for whieh thin pennil iciwmtl,I"I SEWER-SANITARY-STORM EA.31X1 Pf.
Ilot employ troy person in troy comes, y t licensing, IT NCWar4<rf'Ctmpcn- IRGY FF.I;
Z wiml"—of Cuif«nu J J—`7'��7u WATER HEATER WN&N`GELECIR
�7� AppUcam 1 � kADING IIT
rte- y NOTICE TO APPLI eFwr oculang h f - WATER SYSfEM/Il1EA1'ING
F' s- beartr subRiet to the Wert er's Cmn,cab tion pmvision.s of the lshor Code,you rai SOILS FEE
fttMwim comply with each ptvvistom er Nis lrTmit"I h dared moekcd. WATER SERVICE
Q PAID
U0 CONST,is.co CONSTRUCTION LENDING AG1iNCY NI!W RESIDINTIAL YhMB. SU.lI'. Done kecei Y
I hetchy ell Nat dere isemisvuniln lending agetry In the perfmtmtcc of pi
UO Ne users for which Nis lrecom,is isnsed(Sec.8091,Civ.C.)
LI+ [-. - TOTAL
Isulefs Add nifyt INIAL BUILDING OS
f"' 1 1 eagmc than 1 have read this city
sad coon y o slLe mu Ik¢hove infnmutioo E
N Noildm.le¢mcmcomply
and with Jlcityd,en,nrymdiiles ofvd slue lawstelmingm Q'ry, MECHANICAL PERMIT FEE
U � hlilJingnm,arudion,uml hcrchynuNorizcapnxntmivcofNiecit,mcnmr-In Na SBISMICR3E �._.-�+•�•�
above mcnliorrd propcny for inspcuon pm,ocs. PERMIT ISSUANCE
ON.).'mc,to svc,indcromify end keep hmpless de City of Celrnino.'surest 111CTRIC FBI!__\ I I \`
Iiounhie nitignocam.uuu said!expenses which re,in Boy way mernc a¢umt aaiat City A I,TFR OR ADD TO M ITCH,
PUSHING I EIi
in omryunwe o(thc gniming of Inin panni!.
APPLICANT UNDERSTANDS AND WILL CONIPLY WITH ALL NON-POINT AIR IIANDLING UNIT(1010.0X1 CFM)
SOURCE REGULATIONS AIFtf'1,IA. ICFEE
AIR HANDLING UNIT(OVER 10.000 CIN) ONSlRUC1'ION TAX
s,hamlmef App_IwvatC,./.micuorr •� ( Dae./ F EXHAUST HOOD(W/DUCD
HOUSING MITIGATION FEL
HAXARDOUSMdimpoccu,i il'oec SORB -
WllthcepplicanlmfuwmnuildingtecupanlanrremhmdleM1vvdwr material BEATING UNIT(TO 11X1,00 BlVl � ^
ar defines!by the Co,rons Municipal Code,CMger9,12,end Ne Iledth and Safety
Code.StT non 25532(ay! HEATING UNO'(OVER 100.0)0 BTU)
a El No _
VIINIILATION PAN(SINGLE RESID) PAID Dam Re,,e#
Will die ii,"an,m Tamm hal!ding tecupam ua tN.,am,or devices which
•mit hassrdnusahttrvamitivumtkfinadbythc Bry Ata Air Quality Micut,lmn BOILER-COMP(dHP OR IM."BTU) TOTAL:
District? BOILER-C'OMP(OVER IMUM HTUT
❑Yes F7 No
AIR CONDITIONER
I have read We Iwsrdm+materials uQn'veorenu,.ruler Cheryn 6.95 of Ne Ceti- ISSUANCE DATE
forme Hmlth&Safely Coak.Smioms 3551tl,11533 sad L15? 1 makrsnmd thsa if the. NEW RE'_SIDUNHAL M1:CH. SQ.FT
tsolueg dow ur currently Mvc a tnwnt.Ihe,It is toy mlamr
aihility to nrci(y Il a a'cepme
of the rtgtytctte T'ritito A:mn prior yo iawarce safe Coni( M,�
eutMnred ngentL//Y/a.«e�JYTe-re DO¢ TOTAL: ISSUED BY:
OFFICE