99090189 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY O
FR.11,1'111�ADITRESS
CUP N:RTINO RIFLIr1NG.RLECTRIC'AL 19i MITNf
LNG Bit, APPLICATION/PERMIT PIN(;PRNG-n1ncHNI[FIC
I G, Buu,Dlrvc vxodF.f.r u>RNTIe'Icn'nuN
: SANITARY NIL N'I'LICAI'PEN SUBMI'IIAI.DAZE
go s Pop g ?e-3D 4�
NAM[: r P _/S ONT'RAQ'f�) NA 'y_ 'N
J py iY..II13 (d! ('-(� T NIC CON'fR(II,p
ILII I:CI'/I:NGINIRiR: LIC NO: / 1 IS �MLCr J {w .5 ❑
COM'ACP PHONE: / 1V BUILDING PERMIT INFO
� j ❑ Consultant Fens Paid by Applicant(Initial) RLDG I[I.I.CI' PLUMB MICA
U -0& ❑ El 1:1LICENMiIICONTRACII)RSDECLARATION QTY. ITI.FCPRICPtiRA11'r FEE
1 herehy am m
1Rral Iran Rceo.rd nm
odes poovi.ion.of chapter 0(commencing
JOB DESCRIPTION
Cy'Z with Section]glBl of pivisinnJof the Busincmond Professions Cale.and my license i, RESIDENTIAL
W p PERMIT ISSUANCE
Nly2 in to
fine and Otte ol
L ❑SPDWL ❑KITCHEN REMODEL
aVO Ciccone 'las �� TLic.tl AI'PLIANCIiS-RIiSIDEN'1'IAL ❑ADDITION ❑I'I.UMBPSG REPIPI!
rF Z, pate'ITECCS ECL ❑MUhT'I-0NIT ❑STRUCTURAL.
A CI11TIiC1'ti IIIiC1.ARAT10 PANELS
F N Z 1 undersand my,lan..na11 he used ns public records MOIJIIlCAT10N
oZ=o UPTO200AMCS ❑INTFRIOR C]CHIMNEY REPAIR
F�I".,W Limed Prnfcsi ited 201-INX)AMPS IMPROVEMENT ❑SWIMMING Pool's
OWNER-RUILDEIt DEC1.ARA'NON OVER 10N)AMPq ❑EA['lI RIiMC1Ul?I/RIiPNR ❑DIiMG1.U'IGN
C C Q I hereby affirm det I am exempt front the Cuntranm'.License Law for the
3uWy.F following mann.(Section](131.5.Rosiness and Profeesions Cal,Any city n,county SIGNS ELECTRICAL El 91 HER
N which requires a pannit to construct,alter,tmpowe,demolish,or repair any structure `-
F'N0; poor to its .. Iso requires due applicantfor such Wood t fitc a signed_ttamer, SPECIAL CIRCUITIMISC g -
£
In.,,he is 1 Of Ptrr:tnlru in the prosisions oftn e t t r License Low Chapter COMMERCIAL:
�fyp0 (ani ni gw'IL Svri ]t)lltgof U''.vi J f0 ❑ s 11 t '. -Cd,ltr 'TE MR MIT IEIt OR P(IIE INS I'.
aye C thin he is cxanpt dorefrnnl and he basis On, he alleged cxc n,s on.Any m'do.... of ❑NEW I;I,DG/AUDITION ❑DEMOLITION
Section 7031.5 by any applicant for a Period strowty the spPliar,to a civil Penalty of POWER OEVICIS ❑TENANT' ❑FOOD SERVICB
not mom than five hundred dollars($500), IMP VEMENT
£=O O 1,as owner of the property,or my employees with wages as their sole compensation. SR'IMM INC,IKIOL ELECT]RIC
p. willdo lire work.and theorn,one t.not inendedofotlBred lbrwle sec.700.Business 11,E
C and 1'ml'a..inn.Cod,The Conim,nr',Liccnw Law Jou nni upp1Y m nn owner of OUTLETS-SWITCHES-FIX'fURF.S
W
pmpcny who build.pr vides t a thereon,and who Jou such work
te deed or or through
his own employees,Pntvidal thin such improvemen¢arc not intended or offered for NEW R6SIDI:V1'IAL ELECIR SQ IT.
--,If.h,-O-,.the buildingnrimpmm
vemn iswld witu,s
hinoneyof completion.the SQ F-17.FLOOR AREA 9SQ.Irl'.
owner-hullder will have the burden of proving that he did not build or improve for pur-
� l iv-ner of the projivri,,Too excusivdycmtiaetin8 with licenced cmimemw to
construct an,prucd(Sec](HB.Bminu.end 1'mfusions C(xlc:)The Contractor Li-
.c law dues norappytn onowor,of pntpeny who build,or impmvn,thereon.and Q'I'Y. PLUMBING PERMIT FEE
who contracts fur such projects with a conforcur,N)licensed pursuant o the Contractor'.
Licmtse lrw. PERMIT ISSUANCE
� I antexcntEd under Sea .13&P C for thi.re:nun
ALIITS-DRAIN%VENT-WA'1'ITIR(EA) VALIIA'I'ION
Owner Dam
WORKERS COMPENSATION DF,CLARAI'EON BACK IRPW PROTECC DEVICE Q O
1 hereby a1Brm under penalty of perjury tine of the following declarations:
I have and 'll ' t Cnf 't irC a If in. f W kompen DRAINS FLOOR,ROOF,AREA.COND' STORIES '1'YI'Ii CONSTRIICI'ION
µat P I d l I by S 3]t%1 t II L n C 1,. I tam
p rf en of the
ws AI 1' hth'. p t ,-d. IIXTl1RCS-1'IiR TRAP
11 I have and will nu tit Wt rker C t p r 1: til -resI by Section
J lof the lalxm Gnlc.for the performance of the work Err which this stood is issued. GAS-HA.SYSTEM-1 INCA OUTLETS (xTC.GROIII' 35-
Ca
Ca Wt tin ton In ane,currierand Policy f
Carrier Polio No,
_67GAS-EA.SVS'1 EM-OVER a(F.n)
CIiN'fIPICATIi IFE%I1MPI'ION FROM WORKERS' GREASIAINOUS'FRI,WAS TII IN'I I!RCFP`F(dt
CoMP17NSAIION INSURANC1? I31111,UING DIVISION hl?Eti
fr1...section need]out he,omplOhd if the permit is fur one hundred dollars(SI W) GREASETRAP
PLANCIIECK FEE
n..)
Loy any thatinton onymanneeoOhe,work
become
for whichthto the W ekes Coosa- SfiW[R-SANITARY-STORM PA.2fN1 FT.
noumpiny any pcnon m tiny manncr.w+:rs Io Fcrnm,snhjen to the Workers'Cnmpcn_ ENERGY ITE
Z xatiun Lows o1 Culfornia.Uum WATER 11I7ATER WNEN'PHLHCTR GRADING FEE
ZO Applicant
=
NOTICE 11)APPLICANT:11:after making this Certificate of[xemption,you should WATER SYS]FlArl'RFATING S016!4,FF.Iir—
eatme suct to
bbjethe Workers Competnisi
mion provons of the labor Cale,you mint 1
{>•7 fonhwithcomplywithsuch provisions nnhi,prnnnsha111wdeemed.-olid. WATER SERVICE V",
n O I
UO CONS'I'RUCI'IUN I,IiNDING AGENCY NEW RF.SIDEN'I'IAL PLMIi. SQ.I hercley at'BnnllmGOm is a cnmtmain lending agency for me pedonnanec of B. F the Work(or which this Return in issued(See.304],Cia C.)
O lenders Name TOTAL
ITAL
} W Lenders Address 11AIDING FEE
0.rn nv
1 a,aify thin I have read this application and uam thin the above inm
formion is —
wrl.l ugrcc ...Imply with all airy aaA coumy nidi^alta' ad gam lows mlwinB Ut QTY. MECHANICALPFRMIT PPF
SEN11111�1ER
U •z baimmg,na.lmclmn,aaHtereny aaatnd..e«Trc.,m;niva.a of atix city tnenlnr alxm me r
nhove.mentinndpmlwny fm inspection orprsc.. 1 PERMITISSUANCE 1711 CI RIC IEE
(We)ague to sage,ironical and keep hantnc.,me City of Cu,sci ino again
Iidbablies,j.d,menu.coasandexpense.which mayinany uayaccrueagalnasaid City ALTER OR ADDTO MICH. PLUMBING FEE
n.etrvenen of he smnmtg of this permh.
APPLICANT UNDERS'I'ANUS AND WH.I,COMPLY WE ME ALL NON-PGIN"f AIR HANDLING UNIT(1010.1X0 CFM) MECHANICA. -:Ii
SOURCE It EGUhATlUNS.
���— AIR HANDLING UNIT(OVIiR 10.000 CITE) CONSTRUCT' FAX
SignaS plmnnUCnmrucmr Dvc EXHAUST HOOD fWIDBCr) HOUSING MITIGATION FEE
HAZARDOUS MAIERIALS DISCLOSURE
Will the appliou I of tannin,bnildmg occupant store ser handle Im"Tal .nonoral I[EATING UNIT'Oro Ismilto it'I'GO
as ddined by the Curyminti Municipal Code,Chapter 1),12.
and the Ileallh:mJ Safety BEATING I1NI'I(OVER 100.00 i3TU)
Calc Sortie 0 25532(a)^ f�
❑Yes G"" VENTILATION I'AN(SINGLE RE.SID) PAID
Doc Rece
Will the applicant or rumre bai]ding ,,.....t use equipment or devices which ROGER-COMP(3HP OR 110,000 BTIJI
Ill hu'ranlou,air voulun i.:nn,ns Jehnu by In,Bay Amu Air Quality Mmtagcm,r,
IJnoiin? J BOILER-COMP(OVER 100,001ITU)
E]YO. (=N't+
AIR CONDITIONER ISSUANCE D
I h' d the thairinchav itialcriab, y t under2Chapter 645 til theif
fib
1 r 11 Iihffi Safetytl I Section,255(152s toy 12553J.1 d t 1tktrthc NEW RhSIIIIiNTIAI.M1f ECiI. SQ.FI'.
building l tour ilyl� t :rot That'I : Y nesIsansibilityt tl'Y the occapat (Y r
noire mmmtts semen ins .,p a nti,aat,eofn Ccn lam '( cap t,
Own na0honacd agent Dae T(.YIAL: ISSUED BY.
OFFICE