27373 (4) A�PLiCANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
Elf UP,f PEkt'N(i R 'T"° 27373
b�ILbING bLa15LbN APPLiCATibiviPEeMIT PLUMBING-MECHANICAL
BUILDINADD S:,..., SANITARY NO. APPLICATIDNITI
SUBMALDATE
Cb Z3 �.5e, WOLF MS
NAMEPHONEPOMACIP 'S NAM ffv ,/"alVaJ9 /C CONTROL
R NGI ER: LIC NO: Rus: r' �U3� ❑
/ a
ONTACf: P HONE >
BL ELP U B dM
PERMrt IssvANce
LICENSED CONTRACTOR'S DECLARAIION APPLIANCES RESIDENTIAL
JOB DESCRIPTION
PtYZ Ih7(=).f nnthml nmlicm Bduidepw Professions
Codi9(comylicenjwhh
00 SmionRKKl)oflllvbbn]of tAe Budnns and Roferdom Cade.rid mYlkerue ban PANELS
yytyjI full force and eR.t,
<uZ� IJcerte Cau Lk.It ka4 S' UP TO 200 AMPS \`
y 6 Da. Conb.ctw � 20I.1"AMp3
Z FpM AFI ARMITECTS DECLARATION OVER 1000AMP3 SQ. . OOR AREA LSQ.PT.
p Zr I urdenard mY PiaM ihMi be vied u peblk iiioida. �Y
<rn SIGNS ELECTRICAL {�T O
ttnud Profesalon+l
OWNER-BUILDER OEC7.kRAT10N $PECTAI.CIRNIT/hi1SC.
RJ O 1 n�Mbyg oca n.(Se Nd 1 un eacmpi frim de Cann.ctaYe Littnw Ityw forco the
3 folbwine.amn.lSecJmt 10715,Rom"and Rafnalam Curie:My city er wunq TEMP.METER OR PoIP INST.
kaJ H which.quires. mord,w comtmcl,dta.improve,demeli.h,a repir any wuchme
pimcu Mm ivuwce..Iwrequirta the�ppllunl foi+ticli pnMtwnl...iped+Utemcm POWER DEVICES
CE5 <p thit he k licensmed po a to the provWwu of Ile Cmirictw'.Li.Law(Chapter
CK 91 Ingwllh SMUM7 W)of DivWoil]oftle Busisesaud Rofwiwu Code) MMINO POOL ELECTRIC
VALUATION
>>' wSechJuonhe10k7e1.3em-pwthyew.pfpollmnand
fanth•e pbeurmk iftmauthe
tghred exemption.Any or �•� ITFIXTOP"I
>q>q>qq not mane than fine huMted dolly.($SW).,
20 - NEW RESIDENTIAL MECIR _SQ.PT, - I TYPECONSTR Cf10
3k$ ❑ I.nnwwraftheluoleny.mmyemplaYenwilhwege.ulileirwlecompnudan.
win Bothewmk..ndthe oCori.nointenaese iw nor
Bunarof
and Rofessions Cwk:The Contrwmr n License Lew does MI apply m w owmr Of
Pmpnywhu M1nildsnrimpwvw therron,andwhodocaauchwmkhlm.lfwthrwtghhin OCC.OROUNITS
ownemPlvyeex.pmvideJ tbai a pmvemeeisa.rwilnicnded moffumd fm.le.if, +•
howcvcr.Ihe bulldln8t poveme Iswld within oneY�ofrompletian,the owrcr-
budderwillbn Nen Mpmvin the he did rot buildcrI.,r efoepurµwe.f
salc FLOODZONE APN
❑ I,saownerofthe pr Eiedu veiYcontrictingwllllicen.Wcunh.clm.Io y
c roue,Je Pt° .. ( Peofenim.Cudc:)The Contteclml ,�..
tic mel owrteiof whobulldrwlmpmvnlhnem,.d PERMITISSDANCE
wh ' p+o)ecle with, s)licatrd pumunt to the Contrwtol. ALTER-DRAINA VENT WAITR(CA) Zy�u
b tun q_.v. .E a P C foi this rower - _ _ •,
LJ
BACK FLOW PROTECT.DEVICE SANITARY YN
Oce DRAINS FLOOR,ROOF,ARCA,CO b. _ RECEIvrg
WORKMANCOMPE.NSATION UELTARATION SCHOOL TAX Y N
;thereby i/iirm;hail hire icwinnii of tauatlb.ilGhtiurt.w acerJnea¢of FIXTURES- R P RECEIPT
km Compensation ltuuruse m e wnlBed ropy theeof(Sec.7800.Lib C.)which PARK FEE Y N_
inns all employee a under this p IL C;1IJTLEI'8 g
Puli3O BU I DI SIONFEES _
Common, GAM-• .SYSTEM-OVER4(EA) PI.ANNCL'K
f ❑ Cmifid copy is hc.by rmNahed.
❑ CmiOd copy I+fdd with Ute city IvpecOon divinian. OREASPRNDUSTRL WAS GRADING PE
CERTIFICATE OF EXEMPTION FROM WORKERS' UREASE P SOBS ECP.' `
III. COMPENSATION INSURANCE
(Iain action need nmbewnpieadif thepmnit i.ferone hund.d dollar(dl(U) SEWER- ARY-STORM EA.200FT. PlgCQOY D
or leu.)
I eenify that In the petfwmuce:4 the wort:fwwhieh thi.permit k Imud,l.hell L WATER IIEATra WtvC- ELECIR
rei employ any pace•at in any manner an is to become wbjecl to the Wmkesi SAID
CwnpanaaJ.;La..of C.Ilfernia. Doc WATER SYSTEM/IREATING g
z Applicun NEW RESIDENTIAL PIMB. SQ.PT.
,C)7O, NOTICE TO APPLICANT:If.aflci m.Wttg this CcWfl..ie of Exemption,you.hwld 10T
7 : bcanhwhh comply it auchpt Cwnpvu tiis povWomoflleemed Cookol.. moat
foJtwithcmtply with awhpiovlabm alba pcmltdWlhdmrcd.vokd. BUILDIN
[� CONSiRUCrION LFNbINO AGENCY SOSM
z I hereby.anion Thu the.bou
.cmuc0on lending Money fan the P.C.-l'
O the week foe which thln permit b limed(Sec.3091,Civ.C.) 1 PER/
t 1<derti None .
IO � jT PI. MEMO �-
Istdu'+Addrtsa'
t I. I ag Nu I lura ieit tall city
i6dwi and said Ilei the above awl rmulm Is MECHANICAL
121 cm.d. lagrwiowmpld howebyldryud county wdlnusof sad Mete LwamWingw PERMITISSUANCC �'
y bulldingwmuuaian,sari haeby ablltwiu iepiewna0va of UL city tomter upon the FN J�R
CONSTRUCTION TXX
V ti ed o ny fan InspI dl$n pbryww, ALTER OR ADD TO MECH.
(Wel "Fre,idemniryand kwR human.the City of CupMiw agalnnt
lubill udpnm ,curb ode. which iiuyln my way wcruegdnat said City AIR IIANDLING UNIT('IO IO.WCPM)
Jan !
AIR HANDLING UNIT(OVER IO.IKKI CFM)
3= i
Signamnof pplicanw b.e EXIIAUST HOODIW/DUCIT PAID
HAZARDOUS MATERIALS 6RCLOSIIRE HEATING UNIT(TO 103.000 am) Date, %.Lv a
Will the applicant w futue building axupant iiaie,ai handle huerdou.matukl IRATING UNIT(OVER 100.000 BTU) A
u defload by the Coined.Municipal Cade.Chat 9.12.sad the health sad Safety
Code,Semon 2553201E
O Ya ❑No VENTILATION FAN(SING LC RPSID)
SSwU EDATE
Willtha Vplicmi w lama bm
uildingaccupmseequipmenicatic ices which emit BOILER-NMP(IIIP OR 100,000 BTU) F A I D
sand.,.1,conluninana u defined by the Bay Aro Air Quality Management BOILER• -COMP(OVER I040W BTU)hWct7
11Ya 11No NEW RESIDENTIAL MECH.—SQ.SQ.(T. MAR AI Q Q
(� 1995
I here red the hbdo
iru.s;6"eequi.m6 ha
enda Cleft.5.95 of the
Callfnenia Health R Safety Coern de.Sections 25305,25533 and 25534.i undmiwthat T�,
Uh l:Uh'
I If the building don n cur.mly have.ieiunl,that it le my.spbmlM1ility to notify the I11 tl♦�
occupant of the wquiremenls which must b'e met pier In isaumce of.Cedifc.le of
Occupancy. ^'
' owtermantnereed.gant baa A -•,;, isSuEo EY:
OFFFUE