NO PERMIT NUMBER (4) APPLICANT TO FILL IN
CI'T'Y OF, INFORMATION WITHIN RED LINES-
CUPER '"NO USE BALL P
BUILDING DIVISION APPLICATION/PE POINT PEN ONLY
Bun.DINC ADDkfss:�' RMIT a •'•- ...c .k 1.
PLIIMBINp-,l1FCN.5 N'ICAh
1 z� (.� `Ip�� BUILDINCPROJEC l'Ic Ig-yCATION
C( PER,y1T,10.
OWNIJr_'NA`•`F' � C
\V\� O PHON UNIT. O�g,�-Y� S,\NIT,\FLY NO. Y'
11-11'DEC"LENCINF.ER: CO' LOTH "O AI'PLIG'pONSUB,\t
G� OR'S,VAh1E: 7
LICNO. 11 / LICK In�
lt
ICGn7,kCT: ` � —
ADD SS J Noc
PQ a
PHONE Sr CONTROL p
2 3�t9 t , ❑
Qi�Y x GtCTRIC PERM IT yy'r
OOz- Ihemby.lTmIhTNSFD CONTRACTORS DECLARATION PERM IA
"r - RUILDINGP O
uI sccdon Tg)pm nsedunder FE6"? PERMIT INF
sV�XVb ) tD 3m, Business and Profsron CmJeancomin,d my nxeaiin ,`BLDG ELECT
fullfome and elle APPLIANCES-RESIDENTIAL PLUMB W,
Q i License Class on I ❑ ❑ r
y
are Ue.p PANELS L
Z p y< Commcror UP TO 2110 AMPS lOB DESCRIPf10N
OZ-p lindersi nd my I ARCll beard DEC RA ON
Fv_,❑J Pans sM1all be u,ed as public records, =01-1000 AMPS
LiccnseJ Pro— OVER IiN10 AMPS
zLQ
W—>, l hereby a,,,that I onI C,UTLDFR DECLARATION SIGNS ELLCTRICAL SQ.FT FLOOR A EA
following nacos(S<pion)oJLS.Bus nes,s
and
Conuacmre Lie 3/SQ.
rn which m arae Law for she SPECIAL CIRCURg1ISC.
�tayl�•� pnonn its issuance iO a,rtrvet.allea im Pm(eaions Code:Any ciryorcoumy
Jy¢ iequircnbe applition forsuch enolluh,or repair any svucxurt TEMP.METER .
in is!teemed pursuant or he pronsOma ofrhe Co F'On" License Law
yon, 9(mmmencing wish Sectinn)000)ofDlvision3o0 ne Business and gne0 snmmem POWER DEVICES 1
FZQW.y ornai he is aempr nertfmmand the hosts fonheallegedexemptlo Parb fChapmr L..
Sttrion)Bll.3 by an Ro(essions Code) SWIMMING _
2..p marc than five hunJretl'dollanra ce�it subjga ne aPPlicait-.Any
Pham,Of O _FLECDtIC,I ��
laYjF� ❑ I,mownerophepropemy,arra S5�1 Yo OUTLETS-SWIT J
ai_ willdo the wmrk.and nesmiaurc O rminiendedoroffciitbas ale ar, soleco a, 'FlX7LRE5 vALUATI
ycmgloyeeswnh wages as narsolecompensarion, C/r
and Professions Code:The Comracmr's License NE W RF
Pmary whmnmmsnrim law does nor nPPlyman wdameo! AL ELECIR _ �D
Eroves nercon, whuJ a
h°w<�one builemvidednetsuch impmvemcnn assuch work Nnisel(ornmughhis
artnolimcnded orofferedforsaR If.
p STORIES
builder will have the burden ro(vement is sold within one TYPE CONSTRUCT
ole.). Proving Thai he did norbuild or immPlerion.theownery
❑ Lasowne'adhepm prove for puryose°f
'nsmim the pmject(Secce tXamexclucivelycootreaing with lis - TOTAL: OCC GROUP
w cin Did,Business and Proles needcomanc omm QTY. 1! -�4". - '-` RES U ITS
N
se LawdoesmtaPPlY mon nwnerarpm m cions Cotic:)The Contracture ?.Sr2w PLUM
M1ocimtmca formeh Pe Ywho buildaCude -.,a 7r "- xr.,uIS JI
RMITf `r
License Law. Projects wirhaconvacmr(s)licensed Provesrhere°",and PERMIT ISSUANCEe '•P %�'- ,SyM'
t ❑ Ism exempt under Sec. Prsmmmne Contrmmore FLOOD?.ONE
APN
Oxner
--� B @ P C!or this reason ALTER-DRAIN @ VENT-µ,ATER(EA)
WORKMAN COMPENSATION DELL Dam— BACK ROW PROTECT,DEVICE � Fyie�,'h-i'P'
❑ Ihereb EVICE at .f h',?i[gFEE$
Wa Yaffirm that lhaveacenificam olcon ARAI DRAINS- UMMARY=fit,,cgs! '
ken'CampenemmOLaurance ora certifiedera rose!!-insure,oracem, of FLOOR,ROOF SANITARY SIUIi FEF,
r`-'•ns all emploYak unJer Chia co°OPY thercof(Sa.JBtp, AREA.GOND.
Po::ya - cemnir. Lab C.)which FIXTURES-PER TRgp SCHOOL TAX ECEIPTp
❑ Cenifedro CAS-EA_SYSTEM-1 INC.i OUTLETS PARK FEE RECEI�p N�
❑ Cenrud ca PY is hereby fumishcd.
Py is filed win Ne city ins GAS-EA.SYSTEM-0V ECEIPT Y—
cection Division, ER J(FA) BUILDING DIVISION FEES
CERTIFICATE OF EXEMPTIONGREASFJINDUSTRL WAS PLANCHECK FEE
COMPENSATION INSURANCWORKERS- TE INTERCEPTpR
(Thisstttion need not be compiemdifine cemnirA forone hand GREASETRAP
nr less) GRADING FEE
/eeniry nos in Ne performance of the work forty bh!his dollars(5100)
not cmPl SEWER-SANITARY-STORM EA.2(NJFT SOILS FEE
aOy P"°or'n any manner cermit is issued,I shall
z Compen. do V !Cali tecr t rhe Workers' WATER"EATER
WNE.YT/ELECIR [MERCY FEE
O Applicant dm
NOTICE TO APP NT:If aper making this Qnifcam of Escm tion. WATER SYSTEM/1'..
` become subjecrtonATING PAID
fonM1win cora I tars Compensation provisions nfihe Labor Cott
should
PYwilh.ruch pioI'Oine,or this You rant NF.W RE$IDI;,YTIAL PLMB. — T
Q Pamir shall D<deemed revoked. SQ.FT. ktteipr p
CONSTRUCTION LENDING AGENCY
z Ihercbyhill' is 7isaconswaion lending agency fordo rto TOTAL:
rte work for which this,mm,is issued(gee.309), BUILDING FEE
Lenders Name Civ,C.) P" ^nonce of
Leral\ddIi
t] 1 nify that 1 have read this aPPbcmion anJ TA
� L SEISMIC FE
r t 1 gree mcomply with all untl chum scam oat rte above nfonnauon is QTY ,^
building hJ''?\v`MECHAN C'r"a k'arrS, Jnr ELECTRICFEE
YJ l 4 tore nand III amhmreerc rcy"Nmorell and ante lawsrclmingm 'TME CAL PER
-•4�
memioned Progeny to m• P senntives ofns sty 1. ,,,a PERMIT ISSUANCE N•VD' I s E., PLUMBING FEE
(We)agme ro save.mdem,necbmn mirpnsw, Pon the
in
jidgmen¢com de Y and keep hamilns rte Ciy of Cup:nino against M[CIIANIG\L PIiE
xpenses which ma ALTER OR ADD To MI
' mntt of the in Qtr 's ymanywayatemeagainsnsaid Ci CONSTRU
n Trac Oi cermo, b AIR HANDLING UNIT 010, CTION TAX
1 (T 000 CPM)
Signaw m plicanVCo mcmr � 1 AIR HANDLING UNIT(O VER 10,
0 M CFM)
Will rtes pliceIOut buil)nAZARDOUS'ATERI LS DISCLOSURE, •e EXHAUST HOOD(WypUrn
av defined by, CupcnmOMunicipal Cotle pimtmom Orhandlehataord s HEATING UNIT(TO IOO,IXq BTp)
code.Sention 233J2(a)? Chapter 9.12,and the Healnand5afry HEATING UNIT py PAID
❑Yes ❑No (OVER I W,Opp BTU) 1 RccciPt a
the applicamor future buildingncc P VENTILATION FAN(SINGLE RESIDI
air camaminana °pamuse n ]'
1 u defined by the Ba mem mdevicn wbichemir BOILER-COMP
❑Yes ❑Nn Y Area Air Quality Managane., fIHP OR I0(,BBB BTU)
BOILER-COMP(OVER I ISSUANCE DATE
1 have read the M1 �• BTV)
California Health @ Seery
maredols".1ramenis under Chapmr 6.93 of the NEW RESIDENTIAL M
If the building does not cumcmOda Semon 25503.2,55 EGfI.
Jl anJ 235Ja. 1unJeceand nm SG.r7. a•� Jk y
uccupamof be
Oat
mremena hch mea b.that 01,an responsibiliunerstanIn yrte i� .y !
fJmupaney, met prior m issuance Of 0 Cemmiieum of
Jwner nr umhonzed agem
JULF pP 2
Dae p