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99080091 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY O U U O CITY DI CUPVISION RDMB NG-MECHA CAL ICA (TITN BUILDINf.Drv[sION APPLICATION/PERMIT PI.UMRINJECTIDIIANIFIC ' BUILDING PROJECT IDENTIFICATION BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL.DATE I L-1 a 'sYcvrwe. cew�z LI s 4-0-1a & $—�I.E OWNER'S NAME: PHONE: CONTRACTOR'S NAME: LIC NO: 1 650 ST Y 1i N/C CONTROL# -HE MCFAINGINEER: i•-• (•ILL-CINO: 4J / ADDRESS: ❑ d -►9 i ` .ONTACT. •PHONE: BUILDING PERMIT INFO ', alji`�:••' I Cr�L MG1.6l1a#.J G�p 325 `�•f,El Consultant Fm Paid by Applicant(Initial) BLDG ELECT PLUMB MECH LICENSED COM RACTOR S DECLARATION -1 QTY. ELECTRIC PERMIT ii FEE`'„`; 1 hereby f rn for I T d a p fChapter 9 u name g ( . E C,.y - JOB DESCRIPTION yC00 th5 d aIdafecD'' nnlnl theNmi arJcasionsG ds,am yl censers SFIDE ❑KITCHEN REMODEL. FOC in full force and affect. 55” PERMIT ISSUANCE QUU License Class Lic.# APPLIANCES-RFSIDEAL �n Qi Date _ CnnHactor MI11 ADDITION El PLUMBING RF.-PIPE wRCHITLIS DECLARA ❑MULTI-UNIT ❑STRUCTURAL z O y z I understand my plans shall he used.,u hhe recoms PANELS MODIFICATION pz�Q UP102MAMPS ❑INTERIOR El CHIMNEY REPAIR W Licensed Prnfwsinned 201-I00afAMPS IMPROVEMENT []SWIM h INGPOOLS y Y S, OWNER-BUILDER DECLARATION OVER 1000 AMPS ❑BATH REMODEI/RF,PA{R�'pc- TION 6 1 hereby affirm that 1 nm alumna from the Contractor's License Low for the .—�� U following reason.(Section 7031.5,Business and Professions Code:Any city or county SIGNS ELECT'R[CAL FR F In WO a which requires o permit to construct,alter,improve,demolish,or repair any swcture Q qq ..1 prior to its issuance,also requires the applicant for such permit to a argued statement SPECIAL CI RCUIT/MISC. yy y that he is lacrned pumuem to the provisions of the Contractor's License Las,(Chiuor9 p0 (wmmenai nut with Section 70(q)of Division 3 of the Business and Prof Ions Code)or TEMP.ME I'HR OR POLE INS'P. d y o c that he is exempt therefrom and the basis for the alleged exemption.Any violation of N W B��t�IADDITIONDEM N if u. Section by any applicant a permit subjects the apphromto a civil penalryof POWER DEVICES Way ❑FOOD SER ICE I-znot more then five hundred dollars(SStp). OVEMENT 0 I,as owner o(the property,or employees with wages as their sole compensation, SWIMMING POOL ELECTRIC 3 will do the work,and the stature is not handed or offered no sale(See.9044,Business OT L end Professions Code:The Contractor's License Low docs nut apply ,,an owner of OUTLETS-SWI'I CUES-FI%TARESNE .. property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements am not intended or offered for NEW RESIDENTIAL ELECIR SQ FT. sale.If.however,the building or improvement is sold within one year ofcompkiiar the SQ.FT.FLOOR AREA $/SQ,FT. owner-builder will have the burden of proving that he did not build or improve for pur- oC pose of agile.). ❑ 1,as owner of the progeny,nm exclusively cmaractiag withIicem d eontmcmrs to TOTAL: construct Else peject(Se 7046 B -ss and Proiotoons Coe JTh C t anti ta- -. tr I" � use Law does not apply to f property who build: p thereon, d QTY. PLUMBING PERMIT FEE'i ��l V who contracts for such Pmjects with a commctor(s)licensed prostural to the C nhsctorx Q,wQ License Law. asoPERMIT ISSUANCE 3�4P D$ ❑1 am exempt under Sec. .B&P C for this mn ALTER-DRAIN&VENT-WATT VA DATION mer Date OI' }•-4y WORKER'S COMPIiNSATy on DECLARATION BACK FLOW I'HOI'IiLT.DEVICE /�rc�7 I hand will under Certificate to perjury aneof the following declarations: Ihavc and will main by etion 37M of the scid toLabor Code,sure for Worker'sce of tis- DRAINS-FLOOR.ROOF,AREA,COND. STORIES TYPECONSTRUCTION cation,as hick hi for by Section TI011 of the Isbor QrJe,for the perfonnence of the work fur which this pent is issued. FIXTURES-PER TRAP 1 ❑I have and will maintain Workers ante of w rk for hi h his Porn by Section III My of Me Lmxrr Code, the Derlec"a afiit work for mw1h�ic�h this p�e#rmit is issued. GAS-EA.SYSTIiM-I INC.40lffLETS OCC.GROUP APN MyrZ.W. Com VCatio sur nccw IdYcN;cy n14&474"� ©I GAS-EA.SYSTEM-OVER Currier: 'C�JT T CF,RTIFlCATL O EXEM ION FROM WORKERS' COMP17NIATI it GREASMNDUSTRL WASTE INTERCEPTOR (This section need not he completed!ifthe pamrit is for one hundred dollurv(SIM) s F,r d e 9UILDIN _ MSION or Iola.) GREASETRAP PIANCHECK FEE • �� - COO Icenify promise ponaany as he nrk(or whichthispenthe Wikrof olthellpeor SEWER-SANITARY-STORM HA,200 FP. not employ any penom in any munnm nr as m heumtm subject m the Wnrkmrs'Cnmpen- ENERGY FEE y g, g p Oz cation Laws of Cal imams,Date WATER HEATER W/VEM'/ELECTR z Applicant GRADINGFE i y NOTICETO APPLICANT.If,after making this Cenificpm of Exemption,you should WATER SYSTEM/TREATING abecome subject to the Worker's Compensation provisions of the Labor Code,you must SOILS FEE forthwith emau,with such provisions or this petit.shall be deemed revoked. WATER SERVICE Q CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FI'. PAID L) p Ihereby affit that there is a construction lending agency for the performance of Date Receipt the work for which this permit is isanoil(Sec.3097,Civ.C.) l, Q U Lender's Name y TOT r Lenders Address TOTAL. f- 1 cm fy that 1 have I his ptoment and i to that the'Looe information is -- .. s BUILDING F :t- wa y rnrev lagrcc to comply with II cry and ty N ce:and naclaim,m QTY" MPCIIANICAL'PPRMIT, ,'FEE'S / U building construction,and hereby a thori egrwemutives of his city m enter upon the I + a . SEISMIC Ilk above-mentioned properY fonnsPruii purposes. PERMIT ISSUANCE. (We)agree to save,intemnif nd keep hamdoss the Cisy of CUI#'rino against ELE IV L liabilities,judgments,costs ander les whichmayinanyway.cc .gainst,aid C.,y ALTER OR ADD TO MECH. in Ne gmming of is permi P INC EF. .,- APPl6C'ANT I ERSTAN COMPLY INT AIR HANDLING UNIT(T010,000 CFM) MHCHA CALFEE SOL CERE I S a d p / /7 / AIR HANDLING UNIT(OVER 10,0NI0 CFM) CON RUCTION TAX igna en( pelicans/ atm D e / EXHAUST HOOD(W/DUCI) HOUSI MITIGATION FEE !AZAR US MATERIALS DISCLOSURE Will the agDliwnto tare huilding occupant mare or handle ha,ardnos material I(EATING UNIT(TO 100.000 BTU( as defined by the Cupeni ❑No Municipal Code,Chapter 9.12,and the Health and Safety ❑ C. Uses 25532(a)7 HEATING UNI'I'(OVER 100,01X1 If I'U) Yes VENTILATION PAN(SINGLE BESIDE PAID -- Will the applicant or ats a building wpent y A e.Air Qu or devices which Daae Receipt# I hamnluua air contaminants as JcBrte by the Buy Area Air Quality Management BOILER-COMP CHP OR 10i BTIO fimrict? TOTAL: ❑Yes [-I No BOILER-COMP(OVER 100,000 BTU) S AIR CONDITIONER / —.l— ave h mcnts under Chapter6.95of]he Cali- ^ IS�ANCE DATP (ami wish& c.a, s2 outn the tithe NEW RESIUCNTIAI.MECH. SQ.FT ({ Q Q buil ngdces It s y¢ .'bilis mnolif he upam / ( (/ oft respire a be ( auihoomil agent DTOTAL: ISSUED BY: To OFFICE