S 2064 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPfR'17INO BUILDING-RLECTIi Mt]T NO. 2064
BUILDING DIVISION APPLICKPION/PF,RMIT PLUNIBINC-MECHANICAL Mt
BOII,DINC PROJECTIUENTIPICATION
BUILDINCADDRESS. SANITARY NO. AI'I'LICATION SUBMITTAL DATE
- 11
\ OWNF NAME PI OUP' CONI'NA ORIS NAME: hIC NU:
..l f/nr, L1-- r / D �' ; /% / NIC CON'I'NOhM
4RCIIITF.0 IFNUINNHEER: {NUJ IC NO: S ADDRESS: ❑
CON ACT PHONE: BUILDING PERMIT INTO
('r ^9 ❑ Consultant Fccs Paid by Applimnt(Initial) BL❑IX' ELO PLUMB ME❑CII
LICENSED CONTRACTOR'S DECLARATION !/o I
QTY ELECTRIC PERMIT FEE
I he,nay afrna mm I an,I.-,.,d Fwd rnr.irionr or cnnlner 9(rnlllllwncing JOB DESCRIPTION
w0Z with 4mTiun]gYJ)ol DlvirimJnf the Husmnccr acid lmdeaionsCsxle,man my llmn.w l.r PERMIT ISSUANCE REIDENTIAIs
1--1_ in full face and Chattel, ❑SEDWI. ❑KITCHEN REMODEL
tQs..LOU Beene Clans lar.I APPLIANCP_Y-RESIDEN IAL ❑ADDITION El PLUMBING RE,PIPE
N 6 w Omu Ctmmi,mr
F;
R. ARCI11'IliCPS DECLARATION I'ANIi1S ❑NIULTI-UNIT C1 STRUM ORA[,
oiI
Z O'"Z I uwb4nrJ my pions Iml he u J as pohlic records MODIIICATION
OZG UPTO 200AMPS [I INTERIOR E3 CHIMNEY REPAIR
w Licensed Pmfcxsimal 211-1000AMPS INIPROVEhAENT' 0 SWININUNG POOLS
OWNER-O W U I bambymw ,vR nn mm 1 a.,Bse to f anthe 1CRA o0 ....'x License La.For me OVER (0)AMPS ❑ N I:�OD[llltfiljAIR ❑DDI///iJ//M(11.ITION
d fol0rag nw (Seen(,7031.5,Amemosa and 1 ridEs,ions OxIc:Any city dd
c ,ly SIGNS F,I.ECI'RICAL (
ap5. r�c,r�tJl m I l
whim«gave n Permit to eonurvel.ager.iminnve,Jcnwlisli.or nTwir am an.:wrt
f'u'r pwr To iu iuuame.elw mc,in'teit',icaru for—lb pamitm filcesigned I. SPECIAL CIRCUITIMISC.
N duet he is Licem'edpu—md to the mAkino,of The Conmemi'a 1-ecnsc law(CTa,,1rH
w C) (mneelircsr
mnanng Alin Sim 90X)),A D.,aan 3 of the Imoiaml Prufwiann
s Ckl nr ITNIP METER OR POLE INST COMMERCIAL:
d y o K that Iw In umnpl tMrdmm acid Ibc Moi.fur me ullced cccm Pi un.An,violullwi cit ❑NEW BLIG/ADDITION ❑DEMOI.I9'ION
uX]M
ue oi• Scrl'xm 90315 hymy afEinmGx al'c—it-heels tee upplicwl In a avJ pcwRy of LOWER DEVICES ElTy.NAM' ❑FOODSERVICE
not mart dun fisc hundred dollar 1S500).
F Z T 00 INIPROVFL1FNf
_< I,a+rnma oftk Pnolen3'.rr mY empWYc<s Wim xagcs¢a Noir xAc contMscnsaitm. SW'IFI.MING IYIOL ELEITRIC
�P.� will k)thex.xk,end the urunure in ria initiated or offered fm side(Sm,9(W,Rueircms
OTHER
63 2 anal]T rvfessinne 0.1e: [he Cirmmaor's Delon,III,des n all apply To an -a''IF OUTLETS-SWITCHES-IEX'ILRES
pmsemy wlso 1I on imlanvcs dwreon,and wMr dwv such wdk himself d tMagh
hu rwn ett\Moyea,pmvidN tMt such impwvenenu ere cid inmcd]ed a Mfeml fiat NEW RESIDENTIAL ELECTR S T
sale.lf.howc.er,tfr huilJinBdimpmvcnrnt iswWwiminmeyenrofcomldctva,0e SQ.I'I'.FLUOR AREA SSG IT.
nvrhailder will base The burdRo of Er o.ing That he did ds build nr impovc for Pur-
Tam of wleh
L m twrcr of the See.7 , Business
si nol euntrueting Wim.)The,C mrncicmn I- 'TYCAL:
�SILt W CTT ice-,.T,ly]UW..ner as rein cyrisho,arta Cd k:)The 11 thecnr's V-
eemelawdxsmtapplysomowrcrMpmpenywhobuidndinmpsmsesthucm.aid QTY. PLUMBING PERMIT F
xho rnnlfaCL[Gr men prnjms with a umtncmogs)IiameA pursuam In the Cnnhacuws ff-YY
Linin L'w. 1)RKERY CONPI`r ury(smo of ma RJLai�Ndrel/ ALTER ISSUANCE f sJ
E] Into canrt See H k I'Ol al his maw,
SATI
P VALUATION
ar ALTER-DRAIN&VENT'-WATER(G)
c- E
HACK FLOW PROTECT.DEVICE.
T hcrthY a(Enn urdCr P!I g
I bate mal well mmuinmuina CcniOcmcnfGmcennn-¢If-Invurc fiu Wxknrs Cra'tla- HRAINS-PL(X)R.R(N)Is.AREA.CONII. STORIES 'I'YI'E CONSTRUCTION
,,tion,as pmovolid lir by Section 371X1 of The What Cede,fat We Perfurmeme of The
wM fat ssxhich this pmnit is is ubd FIXTURES-PI:R THAT
El I haze and will common WorkRs Compcwtinn home a tee its squired by Seminn
3700.4 the Lahir Code,fnr the perfia 'ar or'be won for ssbicb lmpermit ma dwnd. GAS-EA.SYSTEM-1 INC,J OUTLETS OCC.CROUP APN
My Worl,&,Cmnpcnevnnn Insmro,:yaamuand I bei,no erne.
Cartier: Policy No,: I GAS-EA.SYSIEJN-OVER d TEA)
ChRTIIECATE OI'EXEMPTION IIiOM WORKERS'
COMPENSATION INSURANCE GREASEIINDU.SIRL WASTE INTERCEPTOR
BUILDING DIVISION FRES
(This vstim abed m bccdmplcavd dThe damn,is f ,
muore hdfed JuLlen IS 1X0 GREASE TRAP
d It.,) I'LANCIIECK IEiF.
I terrify that',.The ifumwnce.ftot wm),fnrwhch lbs-sperms,is issued.l shall S1?WER-SANITARY-STORM PA 21X1 PC,
mT employ any pnvmn in any manner so as toeca
bme subject tU the Workers Cntnl'er, ENERGY LEE
O z grim lax<of Cdlfmnla.Dna WATER HEATER WNFNf/GLECIR GRADINGFEEz Applicant
h
NOTICE 10 ANILIOANT.IL v0cr nwking Ghia Ccnifum of Iiaanpion.you slmna d WATER SYSfEN IW ING
F bee. whlaT to the Wurkcre Gmmpcnwoion Pmviainns of TheWlxmr Calc.Y<m nam SOUS PCE
fntmxith comply with auch pruyaiom m this permit slug ed drerteJ revoked. WATER SERVICE
a �
CONSTRUCTION UiNDINGAGFNCY NEW RESIDIlJIImLL PIJNB, SQ,FT LAID
UQIhnmby elfinn lbvuhcrc isawnetructiram lonAing vgc ytrr lha per(omumLnf Uv¢ Hcccipt<
The won forwbicb this Pent Is sewed(See IID.Civ.C)
u' Tender's Name TOTAL:
U Lender's Addeas TO,
LQ1 certify the]1 have read this application vdl sum Thet IhC slave inGxnalimm is q1JOUSING
l agnc h.c... Iyimelldtyandmmutyrndinomcsadlwatelaw.rtdaGnBTo QTY. MECHANICAL PERMIT L) z builfmg edutraciam.amt herehy anmon.omp anrRivc ofdmis city m enwruryam l he ;ls\ 1EoMrvc-rmntiom i M,,eny for inxpcdim puHxuca. PERMD'ISSUANCE
(we)agree us sale,matt mnify and keep hamdn tae Cityof Capcnim againstmus and espenw.sswhich nay in any w'ay de,e against snit City AITF.RORADDTOMITCHLMB � PP.AI'I'IACANT UNUERSCANDS AND WILL COMPLY wall ATA.NON-POINT ALR HANDLING ONTI'1'1(110,(XX)CFM)SOURCE REGUI.ATI(NS. IJ EEAIR HANDLING UNIT(OVER 10.000)CVNUONSTRU 'ION TAY
Sigmure ofApplicamdCcna.mr Dem EXHAUST HOOD(W/DUCO N TTGATION FEE,
IIAYARDOIIS MATERIALS III.SC1.1)SURH
WIII Heapl)licvm or future huddingun,pun some er huddle hucedmr material HEATING UNIT(TO I0f),M)BTU)
n defined by Bin C�per ire Municipal Cade,Chapter 9.12,end The IlwlTh ad Safety
Code.Seddon 25532Id'-' HEATING UNIT(OVER 1(X),(M RTU)
e Ej Na
VIiNfllAflf ON BAR(SINGI.Ii RCSIDI PAID
Will IM tiliaatn nr frame hvildm T uw e t nr Jevisca which Uwc RcYei Ol I
pp Bby beB Em it Qu BOILER (3H1'(1R 1110,LG0 BTU)
L(_�mrtwaatN��dagrol
ms air sanTamNnanu u JdimeJ by the Bay Ara Air Quality MwagarcnT TOTAL_
BOILER-COME(OVER 100.000BTU)
o ❑Nn
AIR CONDITIONER
a rad re hvamdms Taarlvle muuitamnu water Chapter 6.95 d'he Cilie ISSU/ANCE,IJATE
k Stiny Code,Sa\tirma 3503.25513 and 25511. uNedtyyl dam Line NI!w RESIIl1:NIlA1,MF,CII. SQ.FT.
. dt currently have a lenlnt.their it n my ms,comility to mTify the,smmpw a
rtmams which rt <kCYTMy. IatNxf dagcnl Bare 'I'OTA L: LSSUEU BY: � _ 70
0
OFFICE