S 2762 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUTE RTINO Bull,DINC-ELECTRICAL 111IRMI'INo,
BUILDING DIVISION APPLICATION/PERMIT PLUMBING.-MECHANICAL S 2762
BUILDING PROJECT 111RRPIFICATTON L V
BUILDING ADDRESS: SANITARY NO, APPLICATION SIJBMMAL DATE
i� S GL-cJl.)vl� �, � - Le � A
OW'NER'S NAME: PBONp. CONTRACTOR'S NANIG' LIC NO.
/J• // �� NIC CON'IRULM
iARCHTTECTdT'GINPF.H: LIC NO: IG ADDRESS: ❑
CONTACT PHONE: BUILDING PHRNI IT INFO
❑ Cnnsultanl Firs Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
ED z , ❑ ❑
LICENSED COM'RACI OR S DECLARATION QTY ELECTRIC PERMIT FLE
EDO ere
I hhy,arrr„t met Ian,ra,d ilia ptnVi:inn..of CICtI+R 9(ennlmen.�ing JOB DF�SCRIP HON
with Section 71MM0ofl blisku J ofdte Husinlsemal Pori Cbsk.uW m)'It'.o RIRNIIT ISSUANCE R SIDS
FW- in full roccanl,Reel. ❑SFDWI, [IKITCHEN REMODEL
E
QU� Liceasse Clans LicY APPLIANCE'-S-RESIDENTIAL ❑ADDITION ❑PLUMBING RE PIPE
F ZQW lyoc Coan.A-
F D H ARCHITECTS DECLARATION PANELS ElMULTI-INRI]MOOD�'IC-URAL N
ZOa�� luntkrstvnd mY Pl:ms ehull ba tied os pttlk ranrds ' O
OZ-a
UPTO 200 AMPS LQ ❑INTERIOR ❑CHIMNEY REPAIR
GNF Lccnscd Prof"imal 201-10(n AMPS IMPROVENIEX1' E]SWIMMING POOLS
OWNER-BUILDER DFCIARATIUN OVER 1000 AMPS El BATT REMODIRAEPAIR ❑DEMOLTHON
C C vt I M1creby affirm thin I oor C,sc at from the Con radar's License Law for Ohe
a' a U follming revision (.eeciton 7031.5,9usineas and ProRasiem Code:Any city aeeuny SIGNS ELECTRICAL El MITER
3 W y which requircs n Fenno to mnumc0 nitor,imm
prov.doolirh,:n repair any ssmuure
E"p=�g fanocw its iawarce..l.wreyuires the"I"an f,rsuch pumil fork asier tatuc , SPECIAL CIRCUR/N11SC.
f r tial heisllcenw(ipumunmmlMpmvisionsorthn Cannrctnr'.Licen.mlaw(Chaptcr9
WC O COMMERCIAL
(ho be v ing with h.Cim 7666)to Division JofaM Busineu vrd Pofeuiau Cadv)ar T:MP.MEI'I:R OR WIJ:INST
d y o C
ho M is csctnry therefrom and the Nwin far thu allcyed cxe nCfon.Any vi Af,a 1 of ❑yEW BLDG/ADUITIUN ❑DEMOLITION
W�H Satinn]0}L3 by eny applieentfaepemti,whle,b the apPlkvu tow civil PenalD of PoWER DEVICE
[]TENANT ❑PWOSERVICE
l r
nea,than five hutadred do11;,(SNXB. IMPROVEMENT
FZQ tea❑ I.uox nernf me TrapcnY,wmY emPE Ytta with xvgeamthrirsMe cumperevalimt. SWIMMING POOL ELECTRIC
will dr the-als,nal dmamaum if notimcndedundicrsd far.1C(,Sec.71N4,Basin,, El OTHER
la1 and Pmf¢cions Code:The CanaclCrf License law docs trot.,I,In an norther of OU'D.ETS-SWITCHES
-Fl%TURE
,sbrmy who M:ibds a improves Ihrnron,end who our,such weal himself or thmueM1
his own cmg4ayees.IxovidaA Thal such impmventents arc not mteMal w nRennl fa NEW RESIDENTIAL FLEC R
wle.If.l.wever,rh:budding almpnwumenits sold wrhiroa-year ofcumFeflon.the SQ.FP.FLOOR AREA SISQ.IT'
In-r huildcr will have the huNen M 1 r ir,mvl he did or hand a improve for pur-
Pewafwlr.).
of the Fr tPri,,em Cadusiwly amuneting with lice N,mooches In TOT L
r�(y�1
u6,ro,are project(Sec.71144,Busitrse mW Palf—all s CrWe:)The CaruradNe LT
-
nsclawdaesbrotvpPlymanoamrofpropalywhohuiWs or iobrrswes thenen.std QTY. PLUMBING PERMIT FEE
wMs cunwetn Ibr rushµojceu with o conrumgq IicenaM Pun,,,,.m the Grunsaurs
Llccrnc law. I'YRMI'I'ISSUANCE?
1.cacmtac
pt k, .H h PC for thisawn rc
Owrcr _ ALTER-DRAIN Ne VENT-WATFR(110 VALUA9'ION
DLe
WORKIiR'S COMPENSATION DFCIARN'ION BACK 14,OW Pl noECL DEVICE
I thereby air s under awry of pnjuD one M to ow
folling dccWntixu:
I Rvc ad Is 11 mwnwin n Cen idcav of Convent to.rd l-inwm for wakcrs C.O,r- DRAINS-14.00R,ROOFI AREA.CON I), STORIES TY PE CONSTRUCTION
wtian,as VmvidM for by Se rtwn 3700 of to poly,Calc,for the Feck nwce of Be
veal,for which his Permit is isund. PIXTIIRIES-PER'rRAP
❑ 1 have ural will nuiwin Wirkcis Cnmpe¢svim Insumrec,os wa]Uirt by SCCoon
3700oftha Lahr Cask,fortMo perllmtwnreof]hc work Gr whidtthi,a{namit is imued. GAS-EA.SYSI'IW I IN'C.401TI,EIN OCG GROUT' VA API
Nty waters Conyhetwam lmunrce tamer and Policy tnarn r.
Carries link,No: GAS-CA.SYS'DW OVER 4(EA)
CERTIFICATE OF EXEMPTION FROM WORKERS' CRI?ASIYINDUSTRL W'AS'IIiIMLRCIIPIUN
COMPENSATION INSURANCE BUILDING DIVISION FITS
This scctim need
an a completed mit if(he Peris for.hanalmisNLvs(Sllpl GREASE:TRAP
or kw.l I'IANCHLCK FEE
I mtify,Mtin the PeKon^ance atle wok for which oris Froin is iswN,l shall SEWER-SANT -SfOR .''ENI Fr..
not....ploy troy Pimm in wry norma,m m to Geane sahjCC,la tho Waken'C.O,r- ENERGY 141E
O Z aim taxa a California.Dal, WATER IIIALE }TA :NT .. GRADING FEE
z O Applicant
y NOTICETO APPLICANT.IL efer making this Cmificuc of Hinear rim,you sAnld WATER SYSTE AP An RTOTAL Solus FEE
Eccne inbcci In the workers Comlwnvaliml provisions oflhe Lr rw Cade,yon acs 1
11-011 is, 7
famxim comply with such pmwisianaamis Peamit shalledeened scvokd. WATER SERVIC
d
CONSTRULTION LENDING AGENCY NEW RESIDENT PLMP. SQ 17R\N
UO 1hachy.ffimt lout llerc is aconWwticm lending agercy for Be,Perfomuneeof pp1 RettiptY
(•' the work for which thin permit is issned(Sec.J(B],Civ.C.) LSV
O ' I<ndcrt Samc TOTAL_[c ,Adhcsr1 cmifY tMl 1 have rcW this umlicatim anal war that tie above infruntnian is NUILOIN(I, coma,.I egteeto mmMy with ell city and seamy nrdinonccsvnd sutC lows arl-arg to QTY. MFCI IANICAL PER Z handing construction,unl Babyautfarire repred Mm grnwnwives ir city enter uthetiCISMICahavcmentimN pmveny fur insPeaim pu�rn.,s- PERMITI.CSUANCEL'LE.CIR ]FEE O
(WO ag¢e to saw.indemnify anal kevP hair to City of Cupcnian.gainu
Instil ities,judgmeno,costs and egaeo,,r,which nay in any way acerae ago nst said Ch Y AL I'LR OR A DD TU MECII.
in esnsequcne IIn, ting 4IN'Permit. I'LU.M ,'C FFE
APPLICANT L ' ER5TANDS AND WILL COMMA WITH ALL NON-POINT AIR HANDLING UNI'1('10 11,(MMICI N I
A1F.CIIAN1t LIFE
SOUE RIiGU 1/ p
3 ^�7 AIR HANDLING UNIT OVER 10.A)0CFhp CON STRU
ON TAI
ignwum nl Applic..bViolmnm Dat, EXHAUST HOOD(WIDUM) HOUSING MHUGAT10N FEE
HAZARDOUS MATERIALS DISCLOSURE
WII he afflionta fWum haihfingacapon sln¢abandit hauednusntmcrial BEATING UNIT CFO fxmmBTU)
as dcfind by de Culemno nwnici*Code.ClaFter 9.13,an J the Hahn and Safety
Gdc.Sudusa 25532(a)? � HEATING UNIT(OVER HM,(tlfl 111 U)
t
El Y, rJrso
VENTILATION FAN(SINGLE RESID) PAID
Dam RcaiPt N
\4511 me.pplicen or future building CCCuryn use eyuipment,r Mice,whicfi
emit amrdnas air cunaminunts as Mfi:edhylh,Buy Aa-u Air Quallly Isaagennn, BOILER-CUMPtdIIP OR fXl,(MMI MTU)
District? BOILER-COMP(OVER I W.001 B FU)
Elves
I have real le huzaNms nntctials«ymrenew uMcr CtwPacr 495 of Be CWAIR CONDITIONERT- ISSUANCE DATE
Rroie Beaty WnY Code,Stttiw 8503.85JJ aha SSV.1 w.kntend,hal if the N'IiW RIhSIUIiNTIAI.A113CH. SQ,FT. L n
hai Ninga4 s nrntlY huvcalvmnt,taut itisntyircof a enifto '1f oavpwt -3 T 7 9
of prier m 6xarc,of v Crnif�^f
lwnm moa'rcd vgcnr Dale TCTrnL. ISSUIiU BY:
I OFFICE