S1407 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUlaIiRTINO BUILDING-ELECTRICAL PERMIT NO.
BIJILDING DIVISION APPLICATION/PERMIT PING PROJECIADHANIFIC S 1407
BUILDING PROJF:(.1'IDf:NI'IFICA'1'ION
IILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
/03`'1 Gan m
NER'S NAME: PHONE: GGN'fRAGTORS"NAM1i; LIC NO:
, X 4114'1 NaS-xS3-616d ,�1L NIC
GONTkoLk
f SCHITF. NGINEER: y,r 7Z}U�)�g^ 1, ADDRESS: ❑
CONTACT. IQiD jl'HONE: lr �f HUILDING PERMITINFC'
❑ Camathanl Fecs Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
LICENSED C'ON'TRAC'IOR'S DECLARATIONQTY ELECTRIC PERMIT 'FEE
I hereby affirm Isar Earn licensed ander pmvismnx of Chaplor 9 Renmencmg JOB DESCRIPTION
"xZwith Sectinn]IXXRof Uivisinn3aflM Business and Profesxinns Cnde,nnJ my license i.
,0 p PERMIT ISSUANCE RESIDENTIAL:
Not,,i-i Lnfull force lass effect. ❑SFDWI. ❑KI'fCHENRF.MODIr
'' I" Cicerone Class Lick
't-E-) AI'I'hIANCES=It1iSIDENI'IAI. ❑ADDITION MHINC RE('IPE
in 61 Dam Cnmmcua
.)N ARCHITECTS DECLARATIONPANIiLl ❑MULTI-UNIT STRUCTURAL.
a,Z I understand my plans shall M used as public record. MODIFICATION
OZ=q ill'"1021X1 AMT'S El INTERIOR El CHIMNEY REPAIR
t:ac Liccnwcl Professional 201-10N)AMPS IMPROVEMENT 0SWIMMING POOLS
5.1$,,j OWNER-BUILDER DECLARAI[ON OVER I"AMPS
RATH REMODELJREPAIR El DEMOLITION
C Q I hereby affrtm that I am exempt from the Contractor's Licence law for the
X O 6 U fallowing reason(Section](131.5,Puniness and Professions Code:Any city or county SIGNS ELECTRICAL ❑OTHER
W 3 a vOich requires a permit to construct,tutee improve.dam dish,car eapairmy swmma
H u1,or, prior m In isenmmc,ahercgldrev mcappncanl Bneuch perinitto rile o signed statement SPECIAL CIRCUTnMISC.
E a$} that he is Instrurd pursuant to the provisionsofrhe Contractor's License 1awfChapter9
WCQ� Icornencing with Section 7")of Division 3 ofthe Btfuressand ProlessionsCde)or I'EMB METER OR POLE INS'IL COMMERCIAL
:
u:_CO
a G 0 f4 her iter i,exempt Ihcrcfrom and the basis far the alleged exemption Any violminv of ❑NEW RLDG/ADDI'f10N El DEMOLITION
X m P. Sent iun 70315 by any applicunars($5 erndt,athjcctv,ne upplleonuo u dvll finally of PUWER DEVICE ❑TENANT' ❑FOOD SERVICE
W `� nal c Than Evc hundred dollars 15500).
F-Z} re,oftMpepen,or my employees with wagers as t1u,notle cnnnpervition, SWI AIMING FOUR.ELECTRIC OTHER Ii.MEMf
��❑ 'Ill do the work.and thestowme is not intended modlered for sale(See.ID14,Business �DTHER
{ 3 m and Profcssinns Code:The Connector's License Law does not apply In on owner of OU'fLE-1'S-SW' ITS-
FIXTURES
�' his o.n who employee,.
or sided d, such i,and who dues such rinte himself or Ind for
his.If. nnpmr,the provide)f m such improvemums are nm intended or offered for NEW NES AL ELEC'1'R SO Irl'.
sale.If.however,the buildingmimpro.emem is sold within one yearof completion,the SOP('.PLIXIR AREA SISO.Irl'.
pucrdbuilder will have the burJen of proving that he did not builder improve fur pur-
w ol'sale).
❑ I,o,owner of Tho pmpeny,ran exclusively mntmging with Inan.ad m.dualon in OTAL:
consumer the project(See.7044.Business and Prufevnions Code)The Contractor s I.i- P
ser law does net apply to an owner ofPmeray who builds or improve,thereon.and QTY. PLUMBING PIT EEE
cerise
lorsucb projects with aumturef (s)licensed pursuant lothe Contmcter'% a 1Ll,�I((��f
L ours,Law. PBRMII'ISSUANCE va 26 {U\{�D
I ant exempu code,�lL,See. 1N7 Date P C larf/�•/t
( X
Owner_h AL'IISN-DRAINe VEN"f-WA'1'EN IF.1) C VALpUAJON
I bemM1 will WORKER'S'COMPENSATION DECLARATION RACK FLAW PROTECT.DEVICE
CITY Ur UUf ChI11YV
thereby at wrijury me or the Gdlowlng deelannllna,.
i] Ihave and w' Certificate of Consent to,ell�'nu'uc or Worker's Coupon- I'RA1NS-FL(IDR,1100EARIiA,CONDSTORIES TYPH CONS]RUCI]ON
satmn,ax prmiJcd for by Section 3]00 of the IaMr Code,for the pr[onnance of the
work for which Ibis permit is issued, FIXTURES-PER TRAP
❑ I have and will maintain Worker's Compensation Insurance,as required by Section
37IXl of the Leiner Cure for the per Even u:of lire work far which this permit is issued. GAS-EA.SYS'I'I?M-I INC,J I IU'ILETS OCC,GROUP APN
My Worker',Compensation Insurance carrier and Policy ministrant:
Carver: Polk,No.: GAS-EA.SYSTEMOVERJ Its)
CERTIFICATE OF EXEMPT ION FROM WORKERS' GR17ASFJINDUSTRL WASTE RU ERCEPIOR
COMPENSATION INSURANCE; BUILDING DIVISION IT S
(lhls,cclin i readout bee,mlpinal it Imparnif is Ranmchundmddolikus S110) GRISASETRAP —� - _----
orJess) PLANCHECK FEE
Icenifythat in nuTerfomanceoRhe workforwhich lhinpetmi,is issued.l,hlll SIiW1iN-RANT TAH('-S'TONAt EA.21X1 PT.
not employ any season in any manner so as to become subject to the Wmkcts'Compen- 17NERGY ITS
OZ c if lawsofC:dimmia.Dane WN1 Fit HEAJER W'NENT/IiLECTN GRADING F[E
Z Mi,heint '
NOI ICE TO APPLICANT H,aFcr makin6 this Cerencae of Exemplinn,you swaW WAFER SYSTEM/TREAI'ING
F' ? become subject u+the Worker's Compensation provisions of the Lahr Code,you must SOILS FEE;
forhwlth comply with such provisions or this permit shall be deemed revoked WATER SERVICE
Q
� CONS'I'NIICTION LENDING AGENCY NIiW BESIDE N'I'IAI,PLMI3. SQ.F'T. ('AID
V O Ihereby a0inn thm,hcre iso connection lndio&agency[or rhe performance of Unto ceiplX
F the work for which this permit i,issued(Sec.3197.Co.C)
'AL:
V Lender',Add—, TOTAL.
'>y W BUILDING FIT;
I eenay mm I nava roan n1i:avphc:ninr and came Ism the alxwa inlbrnnntinn i,
F N corecl.I agree iocomply with all city and county rrdinancc.and sum law,relating to QTY. MECHANICAL PERMIT ITE
V Z building cnmwalon.and hemby authorize representatives of this city to enter upon theSIi1SMIC TTG
nMwe-inentioned property for inspection purryrses. PERMIT ISSUANCE
(We)ugna m xavq ndcmnfy and kwp hnnnwx Ibe City of Cupcnno aguinat I?LF,CfRI P"t
IWbiluice.judgmenU,cnsuam expense,whichmay in any way aceee again,said City ALI Ek OR ADD'IO MECH,
PLUMBING IBIS
in nnseyuence of the granting of this permit. ,
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALLISON POINT AIR HANDLING UNIT(TO)n0X CFM) MECHANICAL FIT
SOURCE REGULATIONS.
C AIR HANDLING UNIT(OVER 11,000 CI'M) L'ONSTRUCI'10 'AX
gwmre ofTpp reanVCnnnracao Uma EXHAUST HOOD IW/DUCT( HOUSING MITIGATI NILE
HAZANIXIUS MATERIALS DISCLOSURE
Will the appftenm orinmrc hudiinger,tipantsore or handle hmallous material HEATING UNIT(TO IW,(XX)BTU)
as dcfined by the Up+enmo Municipal Code,Chapter 9.11Imd the Health and Safety
Crile,Section 25532(x)'! HEATING UNIT'(OVER 100,N)1 BTU)
C3 Yes ❑No VENTILATION I'AN(SINGLE RESID) PAIIJ
Dare ReceiptX
Will the applicant car future building occupant use vyuipmcm or devices which BOILER-COM('CHP OR UX).000 BTU)
emit haysMnus air contaminants us defined by Ibe Bay Ana Air Quality Managenam TOTAL:
District? BOILER-COM('(OVER HXkgX)H'fU)
E]Yee, F1 No
I havcrcudthc mixeudoe,footrests requirements der Choler 405 of the Cali- AIR CONDITIONER ISSUANCE DATE
y25533 and
un p
builia Health dos at rumy Code.eaintes2550.5,25533am255U.1 mldctscmh Lha II'tne NEW kESIDEN'1'IA1.MECH. SQ.FI'.
huildingd«s not ,whit yhave a,me, that it i,my res of aCiai(ycanosily the occupant
of the reyuircmens which must he ran prior m issuance of a CeniOcme of(larupancy.
Owner or call rundagent Data Tf)l'AL: ISSUEDRY:
OFFICE