S 3386 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUI'ER'"'No BUILDING-ELECTRICAL PE I'I'No
BUILDING DI VISION APPLICATION/PERMIT PLUMBING.MECHANICAL 3386
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO, APPLICATION SUBMI 17AL DATE
ill 2
OWNER" i� PHONE' CON DIi' LICNO:
NIC CONTROhN
( . ARC) TELT/ENGINIiHR: - LIC NO: ADD HIS: f -❑
CONTACT: PHONE. BUILDING PERMIT INFO
/z�T'"til /D ./�yii ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECE
(E!T
LCIiNSEDCONNTRAc TUR BUCLARA'rION QTY. ELECTRIC PERMhI' PEI? LJ
I hereby of na ohm I am keret l ander prnviximta of Chapter 9(aan nelleing JOB DF,SCRIPTION
awz wish Sedloa7WH fDi,i,i ltlofthe Business tmJ Ymfcs,inns Code,anA my llcensc is �O RESIDENTIAL:
WON PERMTI'ISSUANCIi 3 r
F w= in full force and effTyT., 3z3s3 ❑smwh ❑KITCHEN REMODEL
Licemc Class //JJ Lic.p 7 7 / APPLIANC&ti-RESIDENTIAL. C,.,� *
vFi6a hate Contrnanr LJ.(vul'1'ION ❑PWh191NG RE-PIPE
ARCHITECTS DECLARATION ❑MULTI-UNIT ❑STRUCTURAL
FyZ I understand my plans,hill be used.as public records PANF.IS MODIFICATION
UP TO PINI AMPS
cz-,` ❑INTERIOR ❑CHIMNFYRUPAIR
p4kgi Licensed Professional 20I-100MAMPS IMPROVEMENT []SWIMMING POOLS
.4 OWNUR-RUILDBR UECLARAI'ION
I hereby a�nn on I am exempt from the Co anua is License Law lin the OVER HI<INMI AM I'S El BATH HEM011i31/R13PAIR DEMOLITION
fixx'O L U follawid,reason.(Semon 7031.5.Business and Protestors Cash:Any city err an lit, SIGNS ELECTRICAL 0TH
W 3 LL v- which requires a permit to construct,alter,improve,demolish,or mpmr any stmaurc
E"LLO� prior to its issuance.ado requires an,applicant for such pmir m rile a signed instalment SPECIAL CIRCIH'I'/MISC. 10
that he is licensed personalothe provisions ofthe Curnmen'%License law(Chapter)
1+100 (commencing with Section 7000)of Divisian 3 ofthe nosiness and Professions Code)or 'MMP.M61'EROR POLE INST.. ''M
6 M ya that he is exempt therefrom and the basis for the alleged exemption.Any violation of p nLDG/ADDITION ❑DEMOIA PION
..N Section 90315 by any applicam lure cm,saM1ilna the tggtl'mant to o civil lovmtayul POWER UIiVICIi$ ❑T ANT E]FOOD SERVICE
F, urn mom than floc hundred dollars($500). 1 13ROV17MIZNII'
M 01,usownerofthe abitaly.or my indurate, ill,wages as lhci,ateeontpensatin I. SWIMMING POOL ELECTRIC
M will do the work,and the structure is not intended errs
I',offered ll, ale(See 7n44,Business ❑OTHER
L3 :ted Prnfeasdom Call fire Commetnr,License Law dons not apply to an owner of OU'TI.I?TS-SWITCHES-FIXTURES
propeny who builds or intpmve.s thereon,and xho dims mr,work hims if m throuyb
his own employees.provided that such impmvemcrosarc not intended or offcrtd far NEW RESIDENTIAL ELEC 1Z SQ IT.
sale.IL howevee the building orimpmvemem issaldwithinoneyearafcomplmion,the SQ.IT.FLUOR AREA S/SQ.FT.
owner-builder will have the harden of From,that he did not build or improve for par,
,.,aof sale.}
❑ 1,its owner of the property,tun exclusively conaading with licensed contractors to 'T(T g
nimono the IF Jcot(Sec 7044.Rosiness and Prolcwinns Can:)The Canna ova" I- -
seLawdoesnotapplynt an owner of property wlto builds or impose,lhercon,I I] QTY. PLUMBING PERMIT FEE
who contracts for such projects witha cammdals)licensed pursuant m tea Conmmmr's
License Law. PERM]TISSUANCE
❑I am exempt under Sm. .B is P C far this reams
ALTER-DRAIN be VENT-WATER Disk) VALUATION
Owner Data Coe
WOR KIT R'S COMPENSATION DECLA RATION BACK PLOW PROTECT.DEVICE 2�
I hereby affirm under penally of perjury ane of the fol lowing declnmtima Coe
Fl I have and will andintin a Certificate of Conscm In self-insure for Workers Cunq,cn- DRAINS-FLOOR.HOOP,ARIA,CONT. S'fOltl,S TYPE CONS'IRUC I'ION
,uric.,is provided!for by Stolon 39W of tee]arbor Cale.f a the prator nano or Lha
work far which this perndt is issued. FIXTURES-PHIi TRAP
1 have and will nminmin Workers Cooperation n Insurance,as requited by Schon
3700o(tbe I.Nu Qde.fonbe peRarmarcenfihe wnrk far which his permit is sued GAS-EA.SYSTEM-)INC.40VI'I.I7S OCC.GROUP APN
My Wbrke CGS ,tin Insyan vnd Policy nuMsa are. ,...
Cartier �i(,�tLJ "Policy No.: ��� -F,ir GAS-EA.SYSTEM-OVER4 HA)
CERTIFICATE OF EXEMPTION FROM WORKERS' GRIASIIINDU "RhWICS"�NIi CEPIR
COMPENSATION INSURANCE, BUILDING DIVISION Il?f;S
(Thisseetimtwesl no tberoindeodifthepantie is fonmehundred dollars(SHXH G ';'TRAP
nr less.) PLANCHIiCK I HE 2
1 cmtify Ihm In thepenonnanmoftaework an which his permit is Issnad,I [I'lle
nm employ any person In anymannerst as to become subject to the Warken''Cntnpen- SH ({t SANI'1'ARV-ST'OI�A1P T0R-M ENERGY FEE
Z salon Laws of California Date WAT' lf3A'TRU!''E
Z O[> II GRADING FEE Applicata -
Z ryNa NOTICE TO APPLICANT:If,after making this Cvnifirom of Exemption,you shouldWATF IG
JA
a , heetme subject to the Workers Compensation previsions of the labor Cade,you nm_st SOILS FEF.
LkIforthwith comply with such provisions.,,his pond shall Be deemed revoked, WATE .EiRVICE[
0, O
'7 z Ihercby ntlirtn Ce SI RUCTION;ENnIu LINillG STcy Built,perlimnwme of NEWR w SQ.IT. PAI i Mule Receipt#
U tbeworkfor which this period is issued(Sec.7097,Civ.C.)
W (-'t Lender's Name TOTAL:
V Lcndcr's Address T'U'I'AL:
>s 4 1 certify that I have mad this application and state that the mcce infonnmion is B G Flat
E- y coned.!agree to comply with all city and county oblioanms and state laws relating to QTY MECIIANICAL PERMIT FEE
V Z building construction,and herchyaothome representatives ofthnsity renter upon the 'IS IdiF. /
shove-mentioned property for Inspection purposes PERMIT'ISSUANCE
(We)agree In woe,'mdcmnify and 1,111 hunalces the City of Cnpeninn again,( ITEC'RIC PEE
Iiahiline,,jadgmmno.,co,(steed as,enses whi,hotay nnny way accrue againstsald City ALI'BIt Oil ADD'TO MUCH. �Z -Z.D
msequenrenf the granting nllhlspmnit. PLU BIND DELI
APPLICANT'UNDIHIS'I'ANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT LTO 1k000 CFM) D
SOU REC t 1'i'IONS ME ]CAL PI311
� v //y///4/��II ALR HANDLING UNIT(OVER Indian CFM) CONSTR I(IN IAN
SlgnMImerr ApplmanUCo n Dare �j EXHAUST HOODJWMUCT) HOUSING MLT'LGNL'ION FEE
IIA'ARD S MATERIALS DISCLOSURE,
Willm"Plilier Inrluwrt building nccupam store urhandle hm.mdnus material HEATING UNIT TO 1009(XAI BIG)
us dcfined by the Capcninn Municipal Code,Chtmtnr U.@,nnJ the health nnA Sal'dy
Cmlc,Semon ZSAPW)'/ HEATING UNI'I'(OVER I(NI,INNI IITU)
❑Yes ❑NcPAID
VP.N'TILA'IION FAN fSINGl.O RI?SIU)
Data Reipt p
Will the aMdeart or future building occupant use equipment or devices which
anislair etmaminants as defined by[lit Buy Arca Air Quality Manngcmcm BOILER-COMP(311P OR IfX),INM)RTU) (67 TO,
District'a4 Yes ON. BOILER-COMP(OVER 100.0010 BTU)
ALR CONDI'I'RISER
I have rend the Col,Se ions 25505,25533;
55 5,2553 cats under Chapter fi95 of(he Ouli- / ISSUANCE DATE ra
liomin ilenhhk Safety Calc,Serious 35andikoly and25i i1a,4.1 tmade emailtacd thatifthe NEW RI?¢IDENTIALMECII. SQ.FT. (/•(
huilAing does nal,mmtttly love be nem.earn iist c,off.nCaraflaaor fy Hmoeatpant
prat quirt wmd, at be me arrois,t� corn eenircate r e t
Owneror mhmized ugen rte T AL: ISSUED BY: �O
OFFICE