S 2224 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY `VLC1
CITY OF CUPF:RTINO nun,Omc-ELEcrxlcnl, lira n"No
'IN I.1)VISION APPLICATION/PERMIT rLuaunrvc-nlEcnnrvu;^I' J 2224
BUIL DING PROJECT I'IP
IM!N 'ICATION
BUILDING AIIDRFS4 SANIIAItY NO. APPLICATION SUI3MI'I'IAh UA'I'I
1'11(1 P'^/ CUN'1'RACIUR'SN Mli: LIC NO: ^�
17
fiR" A 1
t "•I ' I NIC CON I'ROLIs
.R'xl IicivENGI LICN / AUDRISS: ❑ (� O
CONEPHONE: 13UILDINCI HERMIT INTO
+del ae04#ih 1,r����Za ❑ Consultan(P¢cs Paid by Applicant(Initial) BLDG _ f?' PLUM11 MLCII
LICENSED CONFFRACI'OR'S DECLARATION Q'FY I:I.EC'TRIC PERNIIT 1'610 LrT/ IOHrLIIJ)F$CRI LrPT'-IIO�N
I heresy zllinn that I am reclosed:ander prookium nl'Chaplef v Iroman
mcing
q d'Z whh salion 9akl).r Divlsion3onfae Da.me..a+lad rrnres.hn,.c:We.➢ad myran'd i' RFSIDENTIAL:
W p PERMIT ISSUANCE
C W in full firer and weer ❑SFDWI. ❑KITCHEN REMODEL.
aUU iteme , LiaM mAPPLIANCES-RESIDEM'IAI. UDI'f ION [I PLUMBING III:-I IPE
F z w I.a
uc Co .....
vino
ARCHITI!CrSD1iCLA At[ON PANEIS ❑MUT:I'I-UNIT ❑5'fxl1C'IVRAI.
F tnz lundummnd ou'dwo'luJl M+used no Wthire rrc.mis MODIIICATION
O Z 1111'10 200 AMPS
[3IN'CIiRIOIt ❑CHIMNEY RETAIN
1=4F'LLWI, Licensed Proe.aional 201-10X01AMPS IMPROVEMEN'P (]SWIMMING POOLS
OWNER BUIhDEIt DIiCLARATION
0VER lack)AMPS ❑HATH REMODFUREPAIR ❑DEMOI-ITION
_,,X,
CC I heavy afro+Ihm um 1 exemptal finIll.Contractors Llcenw(.use for the
X 3 CU following mo,Cuo (Section]0.31.5.ro,inns and Ylot....into Col Any city..coan.Y SIGNS f:LECfRICAL ❑OfHEIt
LL: H,N wrier,require.'e lora:,In co mia..alter,improve,Jcmnlish,of n'P➢u may.11'uclurc
prior In iss,inme.ale.rcgaims the mprcam for such Permit,.fileasi,rodsorenenl SPECIAL CIRCUITIMISC.
that he,,limmedpanuam to m a,.inim+.of the Contractor.License law Clapler9 COMMERCIAL:
�IyOO (commencing with Section l00(bor Division 3 of the Business and Pmfcseimm Code)or 'ILMI'ISEI'IiRORPOLHINST.
a a IY Ihm he is exempt therdmm and the hast,Nn the alleged exemption.Any vinlmion of ❑N13W Ii1.UG/ADDI'PION ❑DFM1101.1r109
7C oma Section 90115 by vnyappllcanl for are-'it'subjects the vpplinlm con civil Penally of POWER DEVICES
LV `" lot more man For,hundred dollars($500f ❑TENANT ❑FOOD 5ERVIGIi
'
=Q' I,us nwndn+t the va x11 SWIMMING POO!,ELECRIC INPROVEMIiN'f
T
S ❑ I l!,,omPlnyeea wish wages u.Ihcinole cnanpcnslaj°n' ❑O'CIIF:R
all F willdodrolo, ode mnamum sstolamm�dcd m does
snot apply.9U owner
Y3a and erly wh�hi Cod ind,Contractors,l.iecn.1law Jsesnmapply himself an,soli of Of1TLITS-SWITCRES-ITXrUi
his own coni builds or vided th thereon,and who d,ws meM1 anrd,te dedorf Ihmagb
his own em to des,provided that each Inapmvenrents are n.I imonJ.J m nRamN for NEW RESIDE?NTIAI.I:LECrR SQ I'1'.
p Y SQ.Pr.FLOOR AREA SISQ.PI'.
sawn.IL hnwcvc i the have
th ng 1.r improve enrol is sold,did n one vector completion the
.r-bniWcr will M1uvc the buNun of Pro ing Ihm he did turn huIIJ of in,prn c far per,
ryn1 of oaten. v v � p TOTAL: � �f
❑ 1,u'owtuoofthe See 70y,and sial anal Professions
Coda:)censeronmmnnry 0g(/
construct Ne es arrest(See o ul ns,aId aao Pmfchsma'Coda:)ip.the esmmn.r.n
Li-
raise Wwdts f turnapply man owns,ontract y harmed
ld,ofimpmvcs Comms and QTY. PLUMBING PERMIT' PEE
wM10 contracts for such pmjens with a eunnncun(sl acenned Pnduum¢+the Cnntrwu+rs
License Law. PERMIT ISSUAN'I
. ❑I mneutrai ander See ,B ar P C for this rca-ir
A hTER-DRAIN -WAfHN H=A) VALUATION
Date S-0 p v e7
was WOIiKCIi:S COMPENSA'I ON DECLARAGON BACK('LOW I' t
I hemby allirm under only lot prrjury nnc of the folhm ing deckwaiom
(ham and will mainmin aCeritieum of Cnnannn.Cif-:score lin Worker's Co.,. DRAINS-FLOOR.ROOF.AR. )' STORIES I'YPIc CONS'rR UM[ON
.anon,as provideal for by Section 391X1 of the lahm Colo,for the perfomearc of the 7
irk fur which shin pemail is >sucd. IIX'TUNIS-1'EN'I'R I'
og
I have ,,it will mainmin Workers C.,n,.%tlion Imaranee,as required by Sema.
TIN
3981 nfthe bar CnJc.for ahc pwAnmance nflhe work ria whiduhispenunasissual, GAS-BA.SYSTEM-I -r5 (ICC.GROUP
��� Alf
My WorA art"C: and not r :4/ GAS-F.A.SYS'IES1 OVER 4(' el O/
Carrier: n +mr'P.II t /OO \ (�2
CERTIFIC 'IE OF I:XI:MPI'lQN I R(lh1 WORKERS' GItItASIJINDl15TRl,WASTE IN'I'IRCBP
COMPENSATION IN SURANC12 LDING DIVISION FEES
(Ibi%wttion need nut W completed if the permit is fornnc hmboadollars($100) GREASE:TPLANC 1K 1i
RAP / O
or less) E
I eerily lhm-mlbc peril linam ofthe work ba,Lich this pnnniain issued.I ondi SEWER-SANITARY-Sri M E
EA.2(M)ET.
nal employ any person In any mage,,mss m rearm sobjcenn the Workers'Compen NE - F
,z, onion rosier Caliloraia.Date WAIiR VEArER WIVENTII:I,E(.TR GR I PEE
z O Applicant
NOT ICE;to APPLICAN'1:If,chat m➢king this CCm ficmc of Gxcnaption,you should wAfER SYS'CENIO' PING
a , Iecoore subject.+the Winkch Compensation provisions(if the Labra Code.rim must SOI 'EE
QfoMwi,h Comply with such provisions or this pennil.hall be Jecamed revoked. wArI:R S17RVICI:
CONS'1'RIJ(7TION LENDING AGENCY NEW RESIDEN"I'[Al.PLMD. SQ.Err, PAID`
Ualc 14vcipt M
U O (hereby vlrrm,bat dem is a dnmonaenn leading agency floc the perfarm nemd
I.E.Q F the wnlA for which this permit is issued(So,.31197.Civ.C.) JAL Lender's Naane 'IO'IAL'
Ulender's Addol BUILDING FISH
ELIy I error,mm I Troc rend Ei,appErmmn and'la to 111.1 the above infmmaann As
c meet.)agracmrnmply+uhhall sayandcoulot.nNinunccx and nam laws rcl:sing n, Q'rY. MECHANICALPERMIT FTiIi SEISMIC It.,
U 'Z critical,eonamcdon,umd herhyuadlodre repm,emalives of this city to enter upon 1.r
uh,we-mem ioneJpmpcnyliains 'o....ra,, ses. PIRMI'r ISSUANCI? HLEC IC '
(We)➢gree m save,indemnity and kap hunnln.the City of Cupenino against
Iinhilitle,jadgments,con,emd espenseswbichmuy In any way areae agaim"aid City A.TERORA 11 TOh PL IOr
AAil equNl'UNEQRSTANDS LAND WILL COMPLY WI'T'H ALL NON-POINT AIR fIANDLING 11N1 MEC NICA.FEE
SOU 'HR iUTAI'iONS. r
AIR HANDLINGIJNI RI0,1 CTM) C SIRUCTION'I'AX
. gnntnrc n APPlicunl/C.mraemr Dae EXI IAUS'f HOOD(W 7 IIOU. NG MCCIGAIION 19?E
WJbymocucinfor future builllegJvntualer .chandle
an �A 1 R 100
HAZARDOUS NIApr:RIAI s Drs
a nor hnnJlahaxanlnm m:ncnul IIEAIINO UNI'I'(Cfl a)IM
sustained rI2,.,,it the Health and Safely
Code,Salton 255J2m)! EIF,A'ING UNIT IOV' -Iq,WUlirIf)
❑Yes ° VEEsUIIATR)N PAN . . PAID
Dere Receipt M
s will the applicant or future Wilding occupant mecquipomm or device,.]rich 0or.ER-COMP(31111 ORH
.lot humrJom air contaminants as dcamed u
by the[lay Arca Air Quality Mmgeacm UTA L:
ADame, BOILER-COMPIOVER 100.01X3 B'N)
❑Yes Nn
AIR CONUrHQNER ISSUANCE DATE
I have wd the harawl mwenuls reluircments Imdur Ch➢prtr fi i5 of the Culi
fnmi hh,V Soley GlJe$tt'llVlls 255115,255}1
it 25534.I undersand aha if the NEW RE4IDEN'I IA.MIKE 1. SQ.FE
bei Jing A, inset tiny have a actual Wm it is ny respunsibit',y aloe+ti fybencersom
or + rnryire +anus whichlnunhamcp arm s colaceffilar'd Occupancy
lo
amhornel'agent _ ' ac Tfrr ISSUED HC `�
OFFICE