S 2971 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
F.RTINO IIUILDING.ELF.CI'RICAL PERMI r No,
(:TTY OF CUP
BUILDING ERTIN APPLICATION/PIiRMI'1• PLUMBING,.MECHANICAL.
BUILDING PROJBCr IBRNI'IFICA9'ION
BGILDINGADDRESSI SANT"GARY NO, A'I'LIC 'rlOa Sf fhl DA'rli
__2)_ a 2s S
OW iR'S NAMIiNIC CONTROL#
: PIIONIi: C(INTRACI'IIR:S NAME: LIC NO
1 1
AHCHI rI:CrIE%GINEEW LIC NO: ADDRESS: ❑
CONTACT: VOONF: PLILDING PERMIT INFO
ZS E] Consultant Fees Paid by Applicant(Initial) EE ELECT' PLBMB nff❑CII
wnh Sc Itherr ...t,ltInn3UdcenBaines. pAwkimis If
Q'PY ELECTRIC PERMIT FEB
LICENSED CONTHACIOR
1 ncreb�afOnn that 1 Ian Iiccn,cU undo pnrvisions of Chapmr 9laammenciog 106 DESCRII'I'ION
owz - and PrefeWI,Coll ,nudity license is .O RESIDENTIAL
F PERMIT ISSUANCE -1
in lull l'omelmal elect. ❑511101. ❑KITCHEN REM(llliil.
qU~ Liccntt Class Lic.N
a U APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING k&I'll'13
I-Ztu Ilatc GolltDECL
mQq ❑MULTI-UNIT ❑MODIFICA]IO
AHCIII IEGI'S UEChARA'I'IUN
f-Oti PANELS CHIMNEY R1ON
O Z=7 I unJcrsmnJ my plan.n.ball he uwJ us puM1lia mc d,
UPT021NIAMCS ❑1N'I'Iik10R ❑GHIh1N13Y RIiI'AIR
I:�,t:ad LicensedP eainnal 201-1(NK)AMPS Ih11'ROVF.MIiNT hYN NG
OWNER.1{UILDER DFCLNtATION OVI?R1000AMPS ❑ItAlll RfiM(ll '1 M I� UI�'I'
Iz m¢ I Imem,atnmt that I on excaipt I.ma van Contractor',Liecm.e Law fill the 4
3 F following rea>on.ISmtion Jtp1.5.Bu,incas and I'mfes,ionn Calc:Any city or mm�lY SIGNS ELECTRICAL ❑OI'I{I?k
y which reyuim,u peorn ,,coolluct,all,,,arap rova,dcmolielt,or repair any,are m e
1„q0� n Onal,ion... alkom,uim,he ji,,leatf ,a,h Ilf-migan 11 le I SPEC IA L C I RCIJI'1'IMISC
deal I d. a ab p f he Contractors LLt.(Chapter 9
uc 0 faint 6 with Section7000) rD a 3Ih B ." IPro .Cole)... TEMP MITER OR POLI:INSII COMMERCIAL: U
0.,:2" mach gthcml Isle b.i,t h alleged e pt Ay l' Ptanaf ❑NIiW BLI]Sp .�]DF: Q�.1�'J Y+t/
X^'q 5ccunn]IIJLS by any opplmum fora pe�ntsuhRastheaPPl tam mus vlpen�lty ret I.OWIat DEVICES ❑'11?NANT f —431 14 SI(R
'e not more than Eve hundred dollas(S5o0).
,=0Las ownar of the n IMPROVIih NT
❑ P 11 il Y teen : 'til 'g:as tit ' : Penna m, SHIMMING POOLELECTRIC ❑OTHER
1.. waI1J II A ' III I - flute IJ II Ilia"I IS JIUJ,Bn:
W _ tPIy on -SWICI{E
oTI I1X 1'URI35
0.3 pmpenl h b Ida In coo h J . such kit of though
lis a ply ,pare 1 I that '1 mpp t:am not illendal r d!J for NEW Rh,SIDEN'rIAL F.LLCrR SV Fr.
anln.ll:hw
onxathabuilding lar intps"cn c is,nlA within nuc Ycnndanauplcdnn,file SQ.19'.FLOOR ARBA YSQ.FI'.
owner-builder will have the Murders of proving that he did nm tmilJ or improve fur pur-
LD 1 01 wle.).ancr oI the Property,a xclanisely contracting with awe e'd conosellons I,
construct they
eLathe es not (See JWB.owner
II„and Pmf ho bei ds or
Tho vet thereon.Li-
whoamewdoe.notapply nun with
acepropenywnobuilptnrlmpmvIe thereon. QTY. PIAMHING PERMIT FEE
who«mtmari for such projecd with o enmrumorfs)I Icen.ed pnrxuam m tM Commemfv
License Iaaw. PERMITISSUANCE
❑I am cdempt under See .B S V C for Nis Pen non
ALTER-DRAINS VENT-WATR - VALUATION
Owner Slam
WORKER'S COMPI NSAFION III iC1,ARAI ION MACK FLOW PROI'CC'1'.DEVICE Q
1 hereby affirm under penalty of Perjury one of the following declaration.
"❑I have and will maintain a Certificate ofCunwntlo self-insure for Worker's Compact, DRAINS-FLOOR.ROOK AREA,CONE, STORIES I'YPECUNS'1' UCr10N
,allot,a,provided tar by Section 370wrme Lamar Cale,for the parfamtance of the _
orkl h hflao ..t . ' d. IIXI1JItliS I'I:N'1'RAI' 4/
Fl 1 h d II t %Y kr'.C Pc i Insurance. 4 mJ by Section (�
17001 oftn Labor C s for the Performance of the work for which this permit is issued GAS-EA SYS ITM I INC.J OGTLITS _OCC GROUP !-/AVIS
My Worker,Cot. a.vm of ltwranaet-'e JI ley arab ate/ �l p
Ca.nen Policy No.: GAS-FA.SYSTEM-OVER B(13A) /`
CI;RI'11TCAI I:OF EXCMPTION FROM WORKERS' GRIiASU1NUUSTRL W'AS'Iti INTIiRCEPIOR
C(lMPENSAI ION INSCRANCIC ❑UILUING DIVISION lTIti
(I111„dtior need not lm eontplelal I die"'nil is lore c hundred Jnllan($IW) Ck13ASETRAI' -�
or less.) PLANCIIIiCK Plili
I certify that in the permmance of the work for which this permit is issued,Ishan SEW13R-SAN]TARY-S'IORM EA.200 IT
vol naamloy any per n
any. neer,,,as to bea.mc,IhJeerto the Worker:Ct.....l n- ENERGY FBE
z ,Z srtion leas,of Celllnmiu.DaleWAG Ii1111EArr1{W/V13N'I'Ad-ECA R GRADING F .
Applicant
tall CC'r0 AI'I'1.1CANr:If,after ranking this Cnnamina of EumPtion.you should WATER SYSTEM?REATING
N SOILS FEi
F� neaaao nuhjcca In me Work"I CeloPe nation Pillion"'oflhe Lahor Code,Yon must
lS1 " Iimhwith comply with such proviann,or this pnnnit shall M deemed melted. WATER SERVICE
0
CONS'fHl]CTIUN LENDING AGENCY NEW RES1DIiKf1AL PLMIi. SQ,17 PAID
I hereby ulllna Shit Nem 1,1.sal ou"i....l"Idn"aguney fonhoperfonnacent ale RmciPlN
(Uta F the work for which this peri it is issued(Sec.LIN)].Civ.C.)
IOIAL.
QLemar'.Name
lU Lender's Address T(]"fAL:
}' p� I caddy that I nave mad mi,liptuiealion:od,mtr mal ate a...rotor amOr nt i, By DI
F h correct.l agree to comply with all city and county ordinances and state laws mlatine In QTY. MECHANICAL-PERMIT FEFW�U-10141�'AX
UZ huilJing con."mction,and hereby amtnrim representatives of thiScity pa emnrUp'n the
Ao..nwall Il ,a.,,ny l orin,P.,I purpnnes. PI3HMI'I'ISSUANCE.
(We)agree w,vvc,instantly and knep bar I...the City of Cupantno again" FEE
Iiabilitis,pli6menu,sem,and expenwn whlebnmy many waymeam again"said City ALTER OR ADD TO MECI{.
APPLICANT
NT NthegSIANof than pc WILL
APPLICANT IINDERS'I'ANUS AND WII"I.C(lMi'LY WI'1'II ALL NON-PUIN'P Alli HANDLING UNIT(10 IQIXNI CIM) MECHANICALITE.
SOORCE RP UI.A'IIONS,
0�A It1 'al`I AIR HANDLING UNIT(OVER 10.(00CPM) A%
SignnwmofApPlicanUContmmor Doc I EXIIAUSTHOODOWIDIJCq 71 r
HAZARDOUS MATE 1AI S DISCLOSURE
Will theapplicast or future handing weapantanamn,handle tw.atJous mwarial BEATING ON]I'j0110.00 BT G)
a,dict ned by Na Capcnine Mun'alpal Code.Cba,mr 9.12,and he Health and Solvay
Cold,Section 255320)! H13Ai'ING IJNI'I'(OVIIH 100,000 {'1'U) r"� r
0Yna �N.. V[NIILATI(IN PAN(SINGLE RESID) PAID Ilmc HttciPa
Will Na air contaminants
a building by the mymca Air mualfig areg and BOILER-C11MP(3HP OR IINLIX0 IL'1'U)
`smit ha/uNous air ammminanln as defined by the Bay Arca Air Vuulisy hlu�agcmcm
Militia? ROILER-COMP(OVER 100,010 BTUs
❑VuaNn
Ihal,c read the haraNausnaueriab reyuimmmrit.under Chapter 6,95of the Cali- AIR CONUI'ITONITR ISSUANCE DATE
fomia health S Safety Code.Section.25505,25533 and 25534.1 Interisland that if the NEW RESIDEN'HAI.MECH. SQ.ET. .2 -�
Noldne'Ns uN.....wady ha's.'enaot.that It is lily rmpnisdility vat notify the nnvpamt
ofbhe ire silt.which ain't lease,priarm issuance of a Cenhaaam oI Ocenpancy.
Uwnaa lir tat rat cd abort Dn to 'DYfAL: ISSUED BY:
OFFICE