S 2458 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPF,R'1'INO BUILDING-ELECTRICAL PERM]T NO,
ItUII,DING DIVISION APPIACKI'ION/PLRMIT PING R OJ E MECHANICALIDEMFiCS 2458
Buu,Dlrvc rdo.utcr u>ENrDTcn'ru)N
BUILDING ADDRESS: SANITARY NO. APPUCAI'ION SUIIMI'I[At,DAM
2.3 w e n,R-e, j— Z
O NE '3 NAME' y)yt 'ONTRA1011 ' AMI:: • LIC N)
(� Kill U- bNO 7'4� N 1p, NIC CGNTROI,p
Rc1url:cnENclN1 :R:\\ LIC NO )u y \9enegLsw pa C Q D ❑
CONTACT: PHONE: I dU 1LDING PERMIT INFO
1 _ ` ��^\�^` �� ❑ Collsultan[Pcos Paid by Applicant(Initial) BLDG/ eLO IPLUMB ME❑CH
1V I.1•CIY'i1N:STIOD•`C'IONTRACIOR'SD`Is:CI,,ARATIIONT QTY ELECTRIC PERMIT FEE
1 hereby afr n in.,1 am fietmed ander pmsimon,of Chapin,v(mmmmendng JOB DESCRIPTION
Q it[,SCCden7(ndorpoi,ion3olthe Business and Pm ewinnsCWe.anJ my license is RESIDFNTIAL'
{yO /t PERMIT'ISSUANCIi
�W. in full for, aIf cYt ❑SFDWI. [_1 KITCHEN ItEMOUIih
a-U Liccnx CLss Lica J APPLIANCCS—RESIUIiNDAL []ADDITION ❑PLUMBING RE-PIPIT
FZm Date— Contmaor
ARCHITECTS DECLARATION PANELS ❑AIUISLUNIT []STRUCTURAL
F vii h10011'ICATION
ZOryj Z, IundcmmrJ mY plan ShullMuwA as public nwNs UPH)20o AMPS
Oz,,,O ❑INTERIOR ❑CIIIMNHY REPAIR
UNGPOOL
p.1 t:W Licensed Prot oslomd 201-1(XX)AMPS Ih1PROV1iM1iNT �SWIMNING POOLS
<s OWNER-BUILDER DECLARNION OVER IIXXIAMPS ❑BATH RESIODEUREPAIR ❑D13MDLIT ON
IY C Q 1 hereby affirm that 1 am exempt from,he Cmannn w,License Line for rhe
X O a U following reason.(Section]0315,Busial and Prefessinns Cut Any City or county SIGNS ELECTRICAL ❑OTHER
W 3 a y which royalrcX a hour 1,,consular,mar,improve,dcmnli.ah,or repair any structure
F—p]O< prim li ill imuenco,nlsot'cgnlns the applicant Tor such l'Lx...it ,,lilet'igncdamnmen SPECIAL CIRCUIT/MIS 72
mmheI,do,roadpunaam n,meproviion.s of contractor'.Ltamm.e Law lChaperu COMMERCIAL'
C (commencing with Section 701X))ofDivision 3 of the Business and Proles,hurs Care)or TEMP.MET ER OR I'Ohli
L a c tY that he is excenp,therefmnm and the basis for the alle,el exemption.Any violation of ❑NEW NLUG/ADDI PION ❑DIih101.IT10N
X m_W Section 70315 by any applicant for a permit subjects IM1e up,twanrto a civil penally if POWHR DEVICES OTENANI' ❑FOOD SERVICE
r� of inure than Eve oundreddolle"($51X1).
~+�6 I,e,owner of the nn nn to 'hwa•es as thei—olecole '1Lm. SWIMM INC POOL.11L1i IMPROVEMENT
FFO ❑ 1' Y.Cr mY clop yccs seat b Pcn.a''
El OTHER
will it,,he wod..and,he amacmre I,."(intended monster Iarsale(Sol.7144,Bminesx
L 3 m and Professions Coall The Contractor's Licensc Law Jars not aPEly to as owner of OVI'Llil'S—SWI'I CILES—PIX URI'
propeny who builds or I..prvea thereon,and who does such work hir or Ihroagh
loosen employees,provided def-ch immovcmnenas um not intended o,offered for NEW RESIDENTIAL HLHCTR SQ PT.
,alc.ILhnwmcmte,huddingar lnapnrvcaual ia.wyd whhin nncycurof can.pIrian.the SQ.14.I1.00R AREA S/SQ.I
owner-hunider will have the Baden of proving that he did an build or improve for par-
,I-If safe.), TOTAL:
❑ I.us owner of,he propene am exclusively con,ncming with Iimnwd eontrecmn,o
Construct the project(Sec.7N4,Business and Profewinm Code:)The Comnnoh Li-
cense Law ones net apply loan owner(It property who builds or improves thereon,and QTY PLUMBING PERMIT PEE
whos,nuact,forench prices whhawmtmemr(a)licansalpu Cam oldie Cummek',
License Law. PERh11'I'ISSUANCE
❑ I am exempt ander See. .B er P C for Ihi.meaum
ALTER—DRAIN.F VENT—WATER(IAA) VALUATION
Owner Date
WORKER'S C ft,ed NSAt, Il DECLARATION RACK FLOW PROTECT'.DEVICE O
t se it will
itain a craft,ed Ill he ftgdedmamma
❑ Ihme and will muimxina CertilicnlC of Conunnn cell-insure far N'nrke6 Cumpen- DRAINS—FLOOR,RUDE AREA,COND. N1)µp;S TYP1i CONS'I'RUCI'IUN
Sabo.,as provided for by Seclioi 3700 of the Labor Code,for the performance of the
work lor which this unnit is issued. IIN1 URES PER TRAP
❑ Ihave d 'II o4intain Workers Cpr . i Insurance. byS tion
3710 the 1 h Cal ler d pt ftl k 1 h u 1 dt Is cd. CAS PA.SYSThM-I IBCA OU'rhl?LS OCC.GROUP APNg
M)Worker,C pan ill....mean JI I' Y undwr are. (TAS—LA SYSTEMOVER 4(EA) � 3 �/� •�/
CameoI obey Nt.:
CERTIFICATE OI'IXEMITION FROM WORKE RS' GRIiASI%INDUSTRL WASTE INTURCBfTOR
COMPENSATION INSURANCEBUILUINC DIVISION Flil!S
(I'hlssection need and beenmplved itthepennit is Brune hundreddollm IIXp GREASE IRAI'
PLANCI IIiCK IyiH 40,
Icvrtilymire In IM1e perfnnnanccof the work tireswhich this permit is iswcd.l shall SEWER—SANITARY—Sr ORM ITA.2(X114.
not a tploy any person in any mann ms, �cia�( bjttl m the Worker,'Compere IiNERGY FEE
z sa,ion law C fnm�1Xrf,1)am �I IIIXaso WATER HEATER WNENT/ELECfR GRADING FEC
Applicant
FWIF,if�g This Ceeilionc of Emmptian.Yoa ah W WAHR SYSTEM/i'RE TING
O NNNIII,,,
'Z.y' ti NOI'ICIi'I' CA °0 SOILS pH1i
(~ Mrnnm subject to the Worker's Comlemelon pm oil ol'mhe Labor Olde,you rens
LUforthwith comply with such pnoommo,this perri lsball he deemed rev,aed. WA'1'IIR SERVICE
6 PAID _�
a z CONSTRUCTION LENDING AGENCY
NEW RI'SIDLN IAL PLMµ. SQ. Dam ceipta
hereby ulllrnI that diene.Cn om,tinn leading ngency Ins the perfimmncc et
"a 0cwork fir which this poli t is ioned(See 1097,Civ.C.) '10TH.'.
QIsnder.s Name TOTAL:
} U IsnJcr's Address DING I1Ui1
0. 1 certify that I have read this application mW sum Thal the above information is
F" Z
correct.Ingree,o comply with all city and coumy ordinances and.state lawuelating to QTY MECHANICAL PERMIT FEF n SE]SM, r Bi
U building amooaelion,:md hatch,art rue tepronnuimcs'If'his citym cmc,upnnthe
newcnncntiour'd pro ran,(or impaction pa poem. PERMIT'ISSUANCE ELECTRIC IEE
(We)agree k sac,indermily and keep heroics,'he City A Cam+tine-goitre
Iiebilimiesjudgmemscosts and expenses which may in any way acerae against sail City AIT ER OR ADD TO MECIL I I' h FE
in comcquence of the gaming of this permit.
APPLICAN"r UNDFRS INNDS AND WILL COMPLY WI IALL )N-POINT AIR HANDLING UNI"1'(TO 10,000 And) I MECHANICALiou WINS
.,
AIR HANDLING UNI'I'(OVIIH IILIXN)CPM) CUNS'rRUCfION'I'A
Signature of MpplikilanitlContructor Date EX I MUST HOOD IW/DUCT) TI)N FHH
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or tater,buildingoacumastora or handle haiarduus material HEATING UNIT(10 IINIIXC)BTU)
as defined by the Cupenino Munic'ipW Cure,Cle,ce,9.12,and the Ile:dth and Salify HEATING UNIT(OVER W 100 BTU)
GaIC,Section 25532007 _tl!o/
0 ye, o VENTILATION EA N IS INGLE RESID) PAID
Uma Receipt If
c Will the applicant or future building occupant use equipment or device,.which BOILER—COME OR Int0f1(I BTU)
mil hanvdoua all cnmummands nsZlc line)by the Bay Arca Air Quality Management r0 L: O
Denim? / BOILER—COMP(OV HR 100,000 If I'U)
Yes
AIR CONDITIONER ISSUANCE DATE
1 h Safety
h J u.materials tory t'underChapter 695 (ha Call.
t II'llh&,a rally
S fns 2.5505,25533 Mu,o,
425513.1 .t heal it[lie NEW RESIDES][At,h1CCH, sQ.PI'.
h 'I1' yJ Icor' tiyh' 'I and dntt Y .tut`M1 I'IYI tlYll Pant 7 /
I
cydi rte"yyryyyy�\ham�s.M Lines pnarm uxuanse nru Ccm(y�J col(kcopauy.
I `..... TOTAL: ISSUED IiY: T�
Owneran umhotieeJ Agent Use
OFFICE