S 1053 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF N-PERTINO RU RAUNG-ELECI'RICA I, PERMIT NO.
•BUILDING DIVISION APPLICATION/PERNIFF TING P -JECI!CHANICAL S 10 5 3
xULLDING YRDJFCI'IUEN'1'IF'IGITION
11-DING ADDRESS; s� jSNITARY NO. APPLICATION SUBMITTAL DNI 1.
ER'S NAMII: • Pj/O/Na(19f:/ C RA(T(�R y',Y MIL v ,/ I,IC NO: O
' ^ 4 /m/ ��la/O 6/.jir./r.// CO ROI.p
ARCHOECTIENGINEER: LIC NO: UR"S N ls�NJ
�$SU lrlt5t�e 00,-91t174i` eGvD•,
CON'1'AC'I', PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) LnG ELECT PLUMB MECH
LIn red(UCONTRd uncutSDisioTo M]ONof
QTY. ELECTRIC PERMIT PEE
1 hereby ullirm that I am IicemcJ under Pnrvininm nl Chapter 9(ttmmmncing JOE DESCRIPTION
O0Z wnh Scetion7000)(lDry sian3of the xusiness an JmY license is RESIDENTIAL:
l Wp in �1O PERMIT ISSUANCE
WU full forcendcRmt � ❑SFDWh D�ILi'1T'HEN RF.MODIiI.
QUU Lileri ch APPLIANCES-RESIDENTIAL ❑ADDITION (/❑PLUMBING RIi PIPIT
F-zeJ D m 1.1., a G
holy ❑Mull']-UNI']' S'1'RUC'IURAL
As shall he use Iasip:ARA ION PANELS
F I understand my plans shall h mcJ as public records CHIMNEY
HIMNMODIFICATION
' Z 0 UP' ..g1AMPS OZ- ElINTERIOR ❑S IMMING POOR
F 4.F.u1 hicvnsW l•ndcssimt.l 201-HXu AMPS IMPROVEMENT C]SWIMMING POOLS
C Q y a p OVER 11X10 AMPS ❑tlATf{kEMODE1JRIiPAIH ❑DIiM01.1TION
few,
F- OWNEmBUILDEfroink.gRATION
a C 1 Lerch IErm INn .m uem t from the Cnntrncmr's License Law nnthe ❑OTH13R
X 3 a U following reason.(Section 7031.5.Business and Professions Cohn Any city or county SIGNS ELECTRICAL
W LL y which requires a Permit In construct,alter,improve,demolish,or repair any structure
t: 111 t I 'I: returns- (l applicantt 1t n I -y Jaae Tan SPECIAL CIRCUI'I/M6C.
f, �, but he licensed pursuant theprovisions ftM1 C t t License1 (Chapter9
W�pO (eommemingwid)SectionBan fDivision 3 f the Business and Lrf : sCode)or TEMP MI:'FE?R ORM IX NST. COMMERCIAL'
L L e C that he is exempt therelinat wd the basis for the alleged exemption.Any violation of 0 NEW BLDG/ADDITION 0 DEMOL]'I'ION
XmLL Scaicn](IlL56y anY apPlimm Lnapcnnit zubjeastbe upplinnnn anvil{enalry of POWER DIiVICCS
LL In not nmundum five hundied dolh—(S5(Xp. ❑TENANT FOOD SERVICE
�=,, 01.ac owner of the proMny or my entployen with wages ns their sok utmpcnmtinn. SWIMMING POOL ELECTRIC IMPROVEMENT
LL,Fo will do the wmk,nnd lhcomatme is not imm�deder offend fnrsele(Sce.7(W.Holmes OTHER
LL m and Code TI Contract ti's License L J es not apply ,,an. mcr of GOI1 EL'S SW I'I'CHI S I IX'NRES
a3 property M1 b ild%t improves th rfon J h does.uch work himself at though
his pl y es,provided dr I such p t: a no. wfulc.l or lT ed I n NEW RFSIDEN I IAL EI. CTR SQ Fr.
sale.If,hsnvever.the building orimprovemenns sold within one Year of completion.the SU FI'.FLUOR AREA SISQ�IT
nwnerbuilder will have the burden of proving that he did not build or iinpmve for par. -
ptneef.ale.,. - P A I D
1,a,comer of the prnfsmn am exclusively contracting with licensed contactors m TOTAL:
anter the miiect(Sec.]Ilii.11 mess and 11fcNons Code:)The ConOaaorn Li-
cense Law does not apply n.an nwner..f property whit builds m improves thereon.and QTY. PLUMBING PERMIT .FEE 'no
who contracts for such pngcas with a commamfs)limnedpursuant pursuano the Contr {{//
erm's C 20 ZCD
License Liv. PERMIT ISSUANCE
O l am exempt under Sec ,x&P C for this reason C/f1 :�LV{/
y I F
N Owner Date At fER-DRAIN&VENT-WATER(13A) EUApl�i
�❑ WORKER'S CON PENSATION DECLARATO
ION BACK FLOW PRFEC'.DEVICE s� 1
I hty
ereby affirm under penednt lacilimYone of the fol lowing de,luenon,
e far W..kne,Compen- DRAINS-FLOOR.ROOF.ARIA.COND. S'IORII-STI'I'E CONSTRUCTION
salon,as provided fur by Section 37(X1 of the le her Code,far the performance of the
work far which thin permit is issued. FIX'I ORES-PER TRAP
0 1 have and will maintain Worker's Conipensaien Insurance,as required by Section
3700ofthe bur C.de.Embe crformvnm of Ne worA for whlc hap- in i cit GAS-EA,SYSTI:M-f INC.i OLOLE'FS (ICC.GROUP APN
My Wartrot o yeFrtier and Pull, u t
S' IL
Corrie Policy Nn,: GAS-FLA.SYSTIiMOVI?Ri(ISA/
/ CERTIPICAIE017EXIM141ON PR OM WORKERS' GRIT SMNDUSI'Rh WASTE INTERCEIM)R
COMPENSA'I'[ON INSURANCE ROILDLNG DIV 'ION 1 j S
MN section need not be completed iRhe pvvmit is for one hundred dollar,Of 00) GREASE IRAr
nr IensJ PLANCHIiCK 11311 �•
I certify that in the Performance ofthe work for which this pcmtit in issued.I shall SEWER-SANITARY-STORM EA.21X1 FT
not employ any person many manner so an to became subject m the Workers Compere ENERGY FILE
Z anion Laws of CulNumia.Dae NATER HEATER WNENT/ELECTR
z Q Applicata GRADING Il'
N(HICH'IOAPPLICANT'.IL eller mnking this Crnhicmc of lixmnption,you should WRIER SYSTEMO REA'1'ING
? become subject m the Workers Compensate.provisions of the Labor Cale,>ou must SOILS FEE
Ski
fonhwitheomp]y withwehprivikiomorthis Penna,null be JeemufruvokeJ. WAFER SERVICE
In
6. CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FI'. PAID
U Z nlc Rcccipt#
U Q IM1crehy:dYmtlhat there is:.conslmctinn lenJong.rgasy far the perhrzmmoee nl
F-' the work fur which this permit is issued(Sec.3097,Civ.CJ
0 U Lenders Name TOTAL:
r W Lenders Addrms TOl'AL'.
1 I certify that 1 have read this application and state that the above Infornaion is BUILDING FEE
ttq corna.Ingrccmu.mply withal)city.ndu.mny nedhouncel and state laws refining to QTY, MECHANICAL PERMIT FEE
V Z building construction,and hereby authorize representatives of this city to cuter upon the SEISMIC 1:17E
above emioned pmpery "'aspcaion Purin,¢e' PlilthllT ISSUANCE
el ugrce m svv,indconnry and k ep hcomen v the City of Cuprnine ug.I I ELECTRIC PEI(
liahilitt 'uJgmems.c clad expenses which mayinany way accrue against said Cay ALUM OR ADDTOMECH.
n n e th ram a of od,pernh. PLUMBING Feb
APPLIC. ON 'RSTANDS AND WILL COMPLY WIT({ALL NON-POINT AIR HANDLING UNIT(101(h000 CFM)
SOURCE t�pl TIONS. ^ MECIIANICAI,I'li
AIRIIANDLINGUNI'('(OVER 10,0N)CIeM) CONST RUCTION' 1X
Signature ftA
p anVContmcor Date UHAUST HOOD OV/DUCT) HOUSING ell IGATION 17EHALAk DOUS MATERIALS DISCLOSURE
will thea plica or future building occupwt atom or handle hazalme.material HEATING UNIT 00100.0x0 BTU) '
as defined by the Cuperine Municipal Code,Chapter 9.12,and the H,olth and Safety
Code,Section 25532m)? HEATING UNIT(OVER 100OX)BTU)
O Yes E]No PAID
VEN'I'IL.A'IIONI•AN(SINGLERI'.StDI Date Receipt#
Will the applicant or future building by me B y A ea Air a or devices which
emit haranlnus an cnnmminunts ns AeOncJ by the Buy Arca Air Quality Management BOILER-COMP PHP ON IW.IXM)xTU) TOIAI.
District' BOILER-COMP(OVER I W.000 BTU)
0Ye, ONo
I have read the her ardous materials requirements under Chi 695 of the Cali- A]R CONDI I'IONER ISSUANCE DATE
fomiu Henllh&Safety Code,Section,25505.25533 and 25531,1 underosa that if the NEW R&SIOF.N'IIAL MECH. SQ.FF.
building d.we nm eurremly have.nn.m.de,Of Ivory re,ouoiefify m unity the occuPant
of IM1e requimerems which must M met prior at iauance of a Cenificae of Ocuo'ne.
Owner or aahod,ed ages Pte TOTAL ISSUED BY:
OFFICE