S 0504 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPN:RTIN(1
BUILDING-ELEL7'RICAL 0'NO,
PLUMtlINc-nuGxgnlcA'
BUILDING DIVISION APPLICATION/PERMIT J 0504
tlUII.DFCO
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
75�f o � L� - as ag 7s
OWNER'S NAME' / PILO C� _0
&08GAC.1)ORS NAME:a� �I I / N r NA] CONTROLX
SARCOOD-CPHNGINEER: LIC N(I: AT.S l!/S//Yl�'�(-W�YA Y '(�•� ' /W ❑
F7")of�em�
PHONE BUILDING PERMIT INFO
❑ ConsWtant Fees Peal by APPlirant Qnitlal) BLDG ECT `UMB-l., IFpCII
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
y.firm(hot 1 am 9rcmJOB DESCRIPTION
O=Z ")of Division 3.fthe BurineVancl Prefe.ainn.C^de,aM my li,L"is RFSIDENTIAI.:pp ^ PERMIT ISSUANCE� ndieffeer AO ^5 q 5 ❑SFDW'L ❑KITCHEN REMODEL
V�jvA LicY JAPPLIANCES-RESIDENTIAL ❑AODHHON ❑PLUMBING RE-PIPITQ� 1-f/ 7 • Cmt"rlrx
'Don ARCIIITIiCTS DECLARAMN PANELS ❑MULTI-UNIT OMODIFIURAI.
H Z 1 mularvmid my plana shall he u.d as public%manta MODIFICATION
ZOZ�G UP TO 2N)AMPS ❑INERIOR ❑CHIMNEY REPAIR
a�l_"ul ticasstd lhntessimal 201-I0(OAMPS IMPROVEMENT C]SWIMMING POOLS
W'9'
.1E-,] OWNER BUILDER DECLARATION OV ER 1090 AMPS El BATH RENIODEHJREPAIR C1 DEMOLITION
1'C Q 1 bertby vtimr Nal I tionuempt I.the Comment',Lila.Liw fnr the
KC)off,V f ulrnvine reason.(Section 7031.5,Baca.and NofeWous Cole:"eity nr comical SIGNS FJ.ECTRICAI. [IOTHER
4131y, which rcquirc%a Penmt to construct,alley.(improve,acnmlish,or repair any strucbuc
OQ Pnorro its issuance.also requires the applic t fur weM1 pmluo file vxrgrmd uamrmnl SPECIALCIRCUFMISC. '
yyyCole } that he is licensed pursuant to 9c provWocvs of the Cnmmmor'%IAcen%e lyw(Llopn9
W C) Icornrncrrnng seam Section]OQ9)oflTviaioninftk Buninan vW Rofccsisn%Gdcp. TEMP.MU-fER OR POLE INST COMMERCIAIa
2.a o K that he is caempt Ncretrmm void tk hmis fore be allegul eacmlXrm.Any viobsion if ❑NEW BI.DGJADDTrION ❑DEM101.ITI0N
�-w Section 703 L4 by any applkmt for a Parent whjeas the applicant to a 6"10 IwM POWER DEVICES OTENANT ❑FOOD SERVICE
i.rthou five hndrul moles 1$6)06 IMPROVEMENT
R oue❑I.nuwrnndthe pmPcnY,or,ny einploym with wage us theirsole compcnmtn. SWIMMING POOL EI-ECTtIC El
OTHER
will do tlr wort,and the ntmemre ix nm imemlal oroRcrtd far wlc(.Sec.70H ,Hudness
3 and Pndasiom Code:The Gntr.cmrs Licausc low does not apply to an o ser of OUTLETS-SWITCHES-FIXTURES
pegerty who milds or improves thaeon,ars who arca such work himself or through NEW RESIDENTIAL[I.HCTIf
hi,own empl,.,pmsi Now touch Improrcmcros.act into M.Rad fon
va.If.howcer.Je Wilding ne imprnvertem Is seaman one Yeas mmPlaion.Jc (00jr
FLOOR AREA vs Q.IT,
wmr-hilae,will cove,he buNen of proving my ha did not hild o,improve Incpar- fl
'csa f�,a). I p
❑I,an owner of the PmR'ny,mm esclusivcly animating with Itemised contrxhrn to
construct me pmjm(Sec.]BW,Bu%inea nrxl Profession%Gaal The Contra'mr's I, -h^huilikoc imprwcelfvron.aM QTY, PLUMBING PERMIT FE'Lisxna low. t PHRMIT ISSUANCIi m n �h L
lacmpt under Sec. .H&YCfa rtassre
this
ALTER-DRAIN&VFM-WATP,R(Flo)
Owner Dem VAL
WORKERS COMPENSATION DECLARATION BACK FLOW PROIECI'.DEVICE
'I hereby aflom uMer Family a perTury ac of the hollowing dcdamtimrs:
❑ I have mid will maimai.x Ciratifieste arconessm,to ataitimwe far Wakcls Ceram- DRAINS-FLOOR,RODF.AREA,COND. STORIES TYPE CONSTRUCTION
a mitn,n Pori for by Section 37W of the Iabm Code,fm the perfomunce of the
wok for which Nix pu.nit is msvN. TEXTURES-PER TRAP . .
I have vol will mainum Worse,Comper ihn Imacam".ear"aunt by Section
]f10 of Nc lobar Code.foe Nc Perfonnvmeof Ne soukfforr whhii,halak Jnail is issue. GAS-IA.SYSTI M-1 INC.4 OUTLETS OCC.CROUP APN
Cy Warle'aCRnyc sen;;a pct ( Pniryali%Gt " "A(.Q"01 GAS-BA.SYSIEM.OVER 4(EA)
CIiCHFIC OF h✓/PTION FROM WORKERS' GNLA51%INDUSTRL WASTF.INTERCEPTOR COMPENSATION INSURANCE: HUH-DING DIVISION TEES
(This section meal not ba compincd ifthe permit is Gr are hani dalltm($1B)) GREASHTRAP
or Ecu) PIANCHHCK FCC
I a city ben in be lcrforraruwad,he work Gr which this ry'miil iv Tuts,leM1ull SEWER-SANITARY-STORM IA.200 FT.
rot employ any Perany son I.amanna%n u m beemrc subject I,, he Warkerx'Combe^- ENERGY HE
Z sari..Lau,of CelifarJa.Done WATER HEATER WNEWE' LECUR
Z O Applicant 1 GRADING FEE
F ? NOTICE TO APPLICANT:If,ul¢r mating Nis Cenificabe of Eae"Ism n,yw slXugl WATER SYSTMTREATING
became suhjen to the Worker's Cont,eresauon pmviniom of the Iybrrc Gxis.you nw%t Sons HE
Forthwith comply with such movisitnstuthi%permit shall M1e deenacl revoked. WATER SERVICE
CONSTRUCTION iso NLPNDINGAGENCY NEW RI31DPMIAI,,LMB. SQ IT. PAID
C.10 Thereaffirmy arm(Mac
thrcmvmction k,ding ageecy fur 9c,crltmmuee of Date NneiDN
Me work fa which this N.,is usual(Sec.:NN].Civ.C.)
U. ULencic,Nunn I ATOTAL:
[coda's Addm.vs TOTAL
- arca BUILDING FT J:
Tea , 1cenifyoatIhvv.mixtlli%ty and coonyoanemm the"love.,relufuo is
Z caned lagme ..acel wilhallno[sa coumyodin mal toawardvingtu QTY. MECHANICAL PERMIT FEE
L) Z building eaueuaion,and hereby amhmian repmsenmtives of this citymenter uponth SEISMIC FILE
Nave-rmaanm xid ln.,ny few irtspctirn purptw, PERMIT ISSUANCE
(We)"'to save.EWatemany ami lace,haranku the City of Cupcm.against 'EI.ECf1tIC FF.:
l iabilimes,jvlgrmnls,cos9erid capcmcs whkh may in my way accmcagaiml said City ALTT,R OR ADD TO MECII,
PLUMBING HE
masa,.,m,,ofFaegraningNTN coal
APPLICANT UNDERSTANDS AND
gIL
L COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO IO,IMIfI CFM)
MECIANICALiol
SOURCE
AIR HANDLING UNI T(OVER 100)0 CFM) CONSTRUCT %
S' "vim of Appl' r (Danuvom Dara / EXHAUST HOOD IWIDIIC) HOUSING MITIGATION :E
HAZARDOUS MATERIALS DISCLOSURE
Mill Nanpplietut or future bails ir6 oeeu W^I store sr Mndle havarJ.ws material I IEANNG UNIT TIO 190.(0)BTU)
a%defned by the CuPenino Municlpul Cala.OtalNcr 9,12,and the Health and ea(my
CMc,Sec(m 255320)7 I IHATING UNIT(OVER)00AX)BTUI
E3Yn -1 No VEN`H-YUONFAN(SINGLE RESID) PAID
W de II aWlarenl or foam luilding otcapva use cquipnent m Jevieea which Lane Racip
cmithwarmnx air nxmm�inwm toe Jc9ruvl by the Buy Arta Alr Quvlhy Menag<rmnlNOILER-COMI'(3HI'OR W 110.O990) TOTAL:
District? BOILER-COMP(OVER Iq),Ofl(I BTU)
❑Yn -1 No
AIR CONDTI'IONER
1 have Tal the hvarelaux mmeriels rcquirarcm%uralcr Cheptn 695 of the Cali- ISSUANCE DATE
tomva IIcaIN 9 Safey Cala.Smirarts M!I05,25533 end 25531.I undcmard that if the NEW RESIDENTIAL MECH. SQ,FE
building Jicn not earrcmly leave.ian thw it it;my re,tarsilelay n nonfy the ueealam
of the n,ircircnu which maim he mel Tri^r to i%nwce a.Cacifuale or Occea arcy.
Owrcr o,"mMan'cd ugrnt D=c TOTAL: ISSUED NY:
OFFICE