S 2795 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUI'ERTINO BUH1):N'I:-ELEC'I'RICA]. PERMIT NO,
BUILDING DIVISION APPLICATION/PERMIT PING PROJE IABCNITFIC S 2795
IfI111.I11Nf:PRO.I I!(YI'IIIc:NTIF'IG"I'IUN
BUILDING ADDRESS: SANI'IANY NO. API'IJI At ION SUBMI'TIAL DAI,
lagii t r-lR0315 UJ Ay (?
wNER'S,VAMP PHONE: OM' ACI'Oit 'NA MF.: LIC NO
1)8 AGF _ - 1� Grf 0 N 1(320.2 NIC CONTROL
RCIII'Tf:C'I'IIiN(IINEIiR; LIC NO: A)DRIi55' Z �� Y^J/ ❑
A) t *
CONTACT: PHONE: HU ILDING PERMIT INFO
AL &A ' �� ���-''^�d F1 Consultant Fccs Paid by Applicant(Initial) BLDG ELECT 1'I.UhfR / NIECCII
VRCABEV El El 1:1
LICENSED CONRACToRs D11CLARATION QTY. ELECTRIC PERMIT FEE JOB DESCRIPTION
I hrmby alfirnt that I an liacawd once,Novi....no el Chupmr V B'nmmeneing
Mc70 wnM1 Seninn LNpl of Divi%ionlol[he ltusincss ant l'ndcssionsCede,nnc my license ie PERMI'1'ISSUANCIi RESIDENTIAL:
F n full force and cBec l,{, 102 b� ❑SFDW L ❑KITCHEN REMODEL
QVO Liceme Clues �- Lie b APPLIANCES ❑ADDITION XPLUSIBING RE-PIPE,
FZW Date Cnmmcmr_ .R k—
oi Q y ❑toULTI-UNIT' ❑STRULTUkAI,
F=h AR 'IIITECI"$DECLARN'ION PANT,S
MODIFICATION
z NFP I Tnccotandonyplumehull be u%ed a.,pnblWucarM
OZ- UP'10200AMPS ❑INTERIOR E]CHIMNEY REPAIR
O
M Licensd Pmlcnioonl 201-1000AMPS IMPROVIiMI?NT SWIMMING POOLS
C1C f J OWNI:R-BUILDER DECIARATION
y—y tY Q 1 hereby ulBrm ohm I um exempt from the Condition"Licenu Law for the OVER IIXX)AMI'S ❑BATH kliM(IDEUREI'AIR DEMOLITION
X O MV
d O I'ollnwing nvxon.(Section]031.5,Bminess ant Prnfe%sinns Code:AnY city or county SIGNS ICLGCI'RICAL El t7
W 3 kh which tcynilua a avian'm nmxtrnnIm
.alien parva m
deolish.or repair any amaare
0� pr uno .......r,ad'aac1oe,the applicant lh 1wrialit it)five signed.tl' tcn SPECIAL CIRCUIT/MISC
�y)Y [he,lie i, wenwilp IIn'he 1 - l the Connucan,L I (Chapter 9
1t1�p0 Icmnmrnang whh5minn]INXIkd Disnann3af tM1c l{u.ine.s JPr dcuinm CtdeMn '1 EMP MISI HK OR POLE INS'E COMMERCIAL'
a E 12 C that he i.vIernp,Ihcrefmm and the ba%i%fell the allc,td esampllon.Any violaion of ❑NEW BLDG/ADDITION ❑DEM01.11'ION
SWIMMING Section 7031.5 by any applicant for a permil%objects the applicant mncivil pewlly ell POWER UIiVIC �,, ❑TfiNANT E3 SERVICE
yLy of more[Iran live hundred dollars[SSW). IMPROVEMENT
�S6O ❑ 1,1o%owncml thcpropcty,annycmployee,with wages uv[heiro-nle,»mpnnnmian.
PTH iC'IRI.
Fwill do the wink.and the xtrncmm In not intended arolfcred Rnntle l See.7(94.Basion, ❑OTIIIiR
63 ee and Professions Code:The Contractors License I.tw docs not apply m an owner of OOfLE'I'S-SW'I
pmpeny who builJc or impmvn Ihcrenn,and who Jtes such work htnrselt or through
his own nnployses,provides the.inch fmpmvemenu art net intended ar offered for NEW RESIDENT El.li ! SQ M1 .
%ale.IL hnwoec the htiddingnr impnwcmcnl i%odd withiToac yearofeompletlon,the $0.1['.FLOOR AREA 5/SQ.19
owner-builder will hove the burden of proving that he Aad not build or improve for pur-
"w of elute.). Y
❑ 1.to. ohne pn,peny,ton 1vtl.lillll a alo-olag with liallold cnairaawrx to
construct the project(See 70W1.Businers and Profession,Code:)'Ihe C.ontmetor'%Li-
else Law does not apply to an owner of prnpeny who builds or improves thereon.and QT'. PLUMBING PERMIT FEE
who contracts felr such pro c is with a contmetons)licensed pammrno the Conlmnor's y`
Licence law. PERMI"r ISSUANCE.
I not cel<nhpt under See .R&P C lin bkost.nn _
ALIT?k-DRAIN KVENT'-WA'1'IiR(G) VALUAI ION
Doc
wncr WORKER S COMPENSATION DECIARAI ION BACK ROW PROTECT.DEVICE
I hereby a1Hml under penally of perjury one of the following declarations:
Fl I have and will maintain a Cnificae of Conttnit)wirinsure for Worker's Cooper- DRAINS-FLOOR.ROOP.AREA,COND. STORIES TYPE CONST RUCTION
amen,us provided fur by Section 3700 of the Luton Cute,for the performance of the
walk lit,which thio Permit is iswaf F1XI URES-PER TRAI'
❑ I have and will motna n Worker's Conues"alion Inxurancu,a%Icgnlred by Section
39X)oflhel.ah,rCode lor[hepednmlance ell lhewnrkfor which 11 larO O��eI GAS-ISA.SYSTEM-OVER OUT LETS OCC.GROUP APN
My wnrk�l,r/1 pyy yyh hu�c c r vnA I'nlicy r 3�. _�
Carrier:/- l Tl/` y e �ePulicy Nn.: n
e CIBOIFICA[['01'EXEMPTION FROM WOR KERN GREASI/I N DUST RL WAS Ili INTERCEPTOR
COM PENS At ION INS II RA NCE BUILDING DIVISION FEES
('I his satloTnecdool 1,,I pinccil'thcpmnit lx for on ehundncldollai,6110) GREASR'I'RAI'
I'LANCIIIiCK THE
or le%.%.1
Icenify per in in any nnnnnccof%t teconi whije Itis the
rkcm ed.lshall SEWER-SANITARY-STORM EA.2fN1 FT.
not employ any perm,in any rammer m as to M1ccon¢subject m the WarkcK Cnmpem ENERGY I�lili
z %,tion Laws of California.Dom WATER 1BSCIt:R WNENNIELECTR GRADING FER
Z O Applicant
Iti (/] N(YI'I E10 APPLICAN'1:11',afmr nnking thin Certllione of lixcntplion,you should WAITR SYS'I HNIGREJ11'ING SOILS II?E
benne Xoloell to Ih-Wolkerx Congsn%allon phovixiom arae taboo Code,ria moot
hubwilh mtnply with such provisions torn,pend[shall be dentncd revoked. WN!17R SERVICE
m5 z z that late
LENDING le ng agency
URIT-SIDliPIAIB. SQ.14. PAIDI hcrehyallirm the them i%amrowc[ion lensing agency for the pcdnrmancc of Dae c<eiplMVOthe work far which[his'moat isi"ovel(Site 300],Civ.C.) 'IO'FALU ardv,',v Nao,
l 'I' I.aI ccnify tba 1 have lewd ILi%apPlicminn une[ntetaeux . ItUILUING "iiitq correct.l agreem comply with all city and county ordinances and stem laws relating In NICAI,PERMIT Plili SEISMIC 19iV z huildingos,hunioaandherehy authomcmpresecadves ofthi,vilymente,urym theabove pianioned proNny Inr inopection puH.rscs. ELECTRIC 1(we)ag,ee to save iadermfity and keep harmless[he Clyell Capetian,again.,Inhiliticx,ludgahents,I-Isardcxpen,v,which Tiny:army wvyuccrne agnino paidCityMECIL PLUMBING I'A:
. yuencutf the granting tit this permit.
so Cl ' 'DER S AND WILL COMPLY!r — It'll��i f0� I AIR HANDLING UNIT(OV III,Rican CI CONSANI )L N T
SOURCE EO LATION
AIR HANDLING UNIT(OVER IO.W(1 CPM) CONSTHII"f NTA%
Sign ,o App oaoacnr lute EXHAUST HOOD I W/DUCI) HOUSINGMI'TI( TION FET,
HAZARDOUS MAI FOALS DISCLOSURE
Will tbcapplicam nr lumen haddargtectt, I,arc or handle Isoardus material HBA'FING ON]'1'(A)I(XI,IXX)B TO)
as defined by the Co,oaro Municipal Cade.Chapter 9.12,and the health and Safety HFAIING UNI T(OVER 100.000 BTU)
Code,Section 25532(x)'!
�Ycs GNa PAID
VEN"1'11.K1'ION PAN(SINGLE RPSID) Date Rcecipt d
Willtheapplicant or loop,building oceuPmt nes egtopman ar device%wh'mlt ItOILEII-C OMP(3111'OR Hithr)BTU)
,mi[hamnlono air enmmninumx,%delincd by the Buy Arca Air Quality Mauagcnenl 'I'DIA
Donet] �o BOILER-CONTI(OVER 100.000 RTU)
Ye,
I have read the harurdnus m anal%resry orrielu at Chapter 695 nf,hc Cali AIR CONDITIONER �t ISSUANCES DATE
Tornio Ilwldt.0 Safely CnJe,Seetiom 255115.45533 nnc 25534.1 undunwnd That:lint NIiW RhSIDI:NTIAI.MliCll. SQ.IT, '7
building dtennrncurrenly have anenn I,bal it is no,rexpmnibillty T,moil,thwcctgenI J A /
M lie reyvireralthiehtn t o.ne,prior set i,muacc I,it ilionc of occupancy,
r morn, a6 I au TOTAL: ISSUED BY:
OFFICE