S 2977 (2) APPLICANT-TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPER'1'INO i{DILDING-ELECrRICAL PERMIT NO.
RUILDINr DIVISION APPLICATION/1"ERMIT PLUMBING-MECHANICAL
J nuu.umG I•RWECr uXENTIPICrrB)N'
BICLDINGADDRESS. SANI'T'ARY NO. ATLICAI'IONSUIfbIfl'i DAO:
10317 Vt SIA k "OCL &L -4
Z9 �
VNIik:S NAM[: YIIONG CONTRACSON'S NAME: LIC NO'.
5-tAll 2`-5 '2 rj 7 7 !// rvlc CONTROL X
/'lll'1'IiC I'II'IPry��I EER: LIC NO: ADDRESS: ❑
WCI v/\
CUN'I'nCl': rdow;: BUILDING PERMIT INFO
�� //'-q y�. z /� S��,5 ❑ Caduali and Fces paid by Applicant(Initial) IfhlK Ii1.liCIPLU^belt/ MG^CII'
LICENSED CONTRACT OR's DECLARATION QTY 17LECI'RIC PERMIT FEE
1 hereby i farm mal 1 an licensed ander prmm,slaof Ch.pher n(commencing 1013 DESCRIPTION
m=7_ with Sectio AXIO)of Division 3ofthe liusinesnamll'mfessions C(Ac,andmylicen.wir �^ RESIDENTIAL:
LL100 PERMIT ISSUANCE ( ll
F�.. In lull Once unJ eRcn. ❑SFDW 1. 4KITCHEN kEMODIiI.
<_U L ...imnClass Liust
U APPLIANCIiS—HESIUENI'IAI. ❑MIDI CION ELBY.tfi1BIN(iRI:PIPE
L.Z Iyl Uum Cnnlmcmr
m60. ❑MULThl1Nl'I' ❑MODIFTURAI.
ARCi1lIb vl, UE1-blit TION
~r2 Z nnJensunW my plans shall he usrJ:cv public records UP10PANELS MODIFICATION
r��Q Up TO 2aJAM1'S ❑IN'1'i?RION ❑CHIMNI3V I2EI'Allt
F 141=.1 Liacn.al Prom..io.it] 2111-IIXXIAMI'S IMPROVEMENT EJSWIMMING POOLS
OWNER-BUILDHN UECLARAI'[ON OVER lIXN1AMP$ Q✓'i jBEMODEUREPAIR ❑DEMOLITION
C C Q I hereby affirm mat 1 ran exempt from the COmmemrs Liccme hvw lirt the
X 3 a U following reason.(Section 7031.5,Business and PrOEWon.Code:Any ciry or county SIGNS ELECTRICAL ❑DI'R13N _
W a H which requires a permit to construct,allm.impm,c,demolish,or repair any structure f
E"1=' 4j 1
OQ prion,,it,is....ce.al'. los th
ph e.,liicvat for such permiuo Bmasigned.ummem SPECIALCIHCUI'1'"ISC. / �/' -r
it'iy.J that he i,licensed purwanuo the proviaiann of the Contractors LicercM Law IChapmr9
W�aQO (commencing with Sectian 7(XX)).f Division Sof the Briminssand P' fusions Code) TENIRMENEROR ]TWIST
d Xe y that he is exempt themfmm tad the haxin for the alleged exemption.Any violminin of ❑NEW BLDG/ADDI'T'ION ❑DEMOLITION
_4• Section 7011.5 by any applicant lar a permit.subject%the applicant a civil penalty of POWER Dii ti ❑TENANT ❑FOODSERVICE
than nO Ilse hnoahed Jollurs($51X).t OIIIHR IiMI?N'I'
Fes+ Q [ do40wncnil thitheony,or n,ycmpte c wldlfvmdUa ,Ic Sul.cnml,cus, SWIMMIN iIBI 'RIC
Cr22CC,,t_. will An the work,and thc.tmctium:.Orn late cd nrnffmul l'ur sakfSca 7044,13 uxinc.e ❑OTHI?R
1x13 m and Pro,,,,:ns Code.The Cil .,lots Uect,c Law ews not apply m to wner Of OUTI.
m pmpeny who builds o re
v
anpri)c.theon.aam who doe.such work hi owlfor thro.gh
his own mapimec,pnwidedThat.such impmvanamns am not intended Or offered Int NEW RE.SIDIS L'.'N °I:
sak.l[M1awocr.[be building or impmvanent is sold within one year or completion..... SU.PC FIAXRARBA VSQ,171'.
acom-Istildur will have the buNen of proving Ihat Im did not build or improve fill pur-
Sit of wded.
El 1,as Owner of the propcny,am exclusively contracting with licensed contractors m (1TAL:
mstrua the project(Sas 74q Business and I'ndcsnimm Cade,:)The Contractor's Li-
censcLaw does not apply u,an owner of property who build%or improves thcaon,and QTY PLUMBING PERMIT EEE
who c ntrmry for Mch pmjccn with a cmmoamodO IicmxwJ pursuant u,the CwaructOre
Lice.®Law. PERM]T ISSUAN1➢?
ElI ran cxcmpt a JI1 h 1'C for Au"cnvnn
cc —T ALI KIr—DRAIN k V17N'I'—WAS ER 07AI VALDATION
[)am
WORKER'S ,olperA'IION DECLARAI folloin, BACK FLOW I'HfYfl!CI'.DI?VICP, x3 U9 D
I hmal ill rmuunta cnammeofrlurynncnfmcfollowior dmlumtiuoa:
I have unJ willnwinininx Ccnilicacol Conscm In self-insure lin WndcYs Cnmpcm DRAINS—FLOOR.ROOI(ARIiA.COND. STORIF TYPE CONS'I'HUCIION
.coon,vs provided for by Section 3701 Of the later Code,battle pefforroubc of the
ilk lie which this permit is iasucA. FIXTURES—PER TRAP / r
❑ 1 have and will malnmin Worker's Compensaion Insurance,as required by Section v
TRX)of the laMn Cade,for the performance of the work for which this Permit is issued. GAS—F.A.S YSE.M.I INC.q OUTLETS (JC'.GROUT' AFN•3
MyWorker's Compensation Insurance turner and policy number am: GAS-EA.SYSI'IiMd)V[R4(EAI ,� Zee at1t1�S
Carrier: Pul'my Na: �Z
CERUITCAI 17 OF EXIiMPI'ION IBOM WORKERS
COMPENSS11ON INSURANCE GREASEIINDUF'I'RL WASI'C INTERCEPTOR BUILDING DIVISION PILES _
(IBi....lion need nal he enlnplcmdinuun
fthupermil is fur c hundred dollars S 1(10) GREASE'II(AI'
of less,) PLANCIIIiCK dill
Iceniry mat in thcpMannanccofthe work farwM1ichthis pencil lsisxuM,lshall SEWER-SANI'1'AHY-SIORM EA.2(XIFr. -,
nw cndploy may person in any intoner so as to become omoct to the Workers'COntpat, r PNERGY IBiIi
Z .Moon Laws of California.Dna WATER THAI'ER WOVEN'VELECfR Ill l
ZO Applicant c-6RA6IM1G IgiE
N N01 ICE:TO AN IL alter making this Cenificae of Exenaptinm You nMmld WATER SYSTEMrIRIiAI'ING L
a ? becooe suti m m the worAdz Com tion f the LaMn Calc,Ynu meet ')SOIt51t5
pensa pmvaanvxo {{ "ll
W
fordwall comply Vim such provisions or this permit shall Is,deemed revoked. WATER SERVICE IL I
o v
CONSTRULTION LENDING AGENCY NEW R[.SIUENI'IAh I'I.MB. S P' � PND
] 'Z I herchy affimuhm there i.0 namelion lending agency for perfnnnnnae ill ( r, Dom Hecuiptp
J
me walk m:wmmthis di.is.a�..Ifgee.309zae.c.) I rat—
F rami
C) U I.cmlat.a NMlae 'I(yI'nL
I oily ohm I hove read thin nppheanon and some Thal the uls,ve infmmunun is BUILDING ATE
¢
F-' 1 correct.I agree In comply with all city and county undinroo,,and nate laws relming Io QTY. MSCIIANICAI,PERMIT FBF SEISMIC FT
UZ building urommlon,and hefchy:mth...no repmxnatives of this city to enterupon the y ED
aMwummntinned pmpeny for impaction purposwv PERMIT ISSUANCE + O ELECTRIC I '13
(0.'q agree m.ave,inJenmify and keep h..,lcs,the City of Cupcetino against
liabilow,judgmcros.cose.nd expcnxs which may inanywayvccmeaguimuaid City ALTER OR ADDTO MIKES. PLUMBING FM +
APonwyuence of the grating of this wralit.
PUCAN'1'UNDERSTANDS AND WILT.COMPLY WITH ALL NON-POIND AIR HANDLING UNI'I'(TU IO.(1(IOCFM). ' MECHANICAL. 'Ii 0
SUUNCIS REM S.
49
AIR HANDLING UNIT(OVER 111.000 CPM) CONSTRUCI'ION9'A
S mntmm� pplicuntlConwe r Dam EXHAUST IIOOD(WIUUCf) HOUSING MI'I'IM'r10N FIT
HA%ARI OSIS MAI SERIALS DISCLOSURE
Will theapplicaut Or lama hail&ngo,,a,aw,1om or hawlchumdnn....a nal HE,A1 INC.UNI'1'1'10 1X1.IXX)B'I Or
lis denied by the Cramoo Municipal Calc.Chapter 9.12,and Ota Meath and S.Imy
Cd de.Section 25532(.)? HEATING UNEi'(OVIM gk(XNl BTU)
0 YO, 4 VENTILAIION PAN(SINGLE Rat Of PAID Dmc RccciptOr
Will the appliewit or Douce building weritunt aw ryuipment or devices which BOILER-COMP Ud II.OR 100.000 BTU)
it twwdous air contaminants as JytinN by the Bay Area Air Quality Mium,pr cut TOTAL
)%trier? //'/ BOII,F.H-COME'1UVER 100.000 B-TU)
0 Yea17
1 h- w! he M1 t ird,aNtannual,maker Clri,wr 6)Sul the lull- AIR COUOI'I IONER ISSUANCE DATE
I'or ' Uv I,isSmb,Code.S d SS(IS 25533and2553a 1 undrOlanddU it thc NEW RLSIDLN'ISAL MI?CIi. SO pir
Knill 61 ,t cu s dyl t I,II t t y P 'bltyt 'f I c'I,m /
OPT s Ilw nd pdd ria sn un aCuil t )up:r
cc lc t n1sN agent ate OTAI- D ISSUED BY: ty �
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