S1543 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPF,RTINO BUILDING-ELECTRICAL Pr IT NO.
BUILDING DIVISION APPLICATION/PERMFPPLUMBING-MECHANICAL 1543
BUILDING PROJECT mKFnFICATION
BUILDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE.
10'560 C 1 le
% O I \N:M 1'flONli: CO RACT R1 NO `NI ILU LIC NO:
NIC /�—CfINI'R LA
•i ARCy>rTP /ENGIN1;tR: LICNO:j;qqj ADDRESS: ❑ (? /�2
CONTACT: rV1 PHONE BUILDING PERMIT INFO
S10,2 2 Consultant Fees Paid by Applicant(Initial) ELECT PLUME MECH
LICENSED CONTRACIUK'S DLCLARAHON QIY FLECTRIC PERMIT FEE
I Neaten,mrml mat 1 and rased atter rys'vinion.nr Chaplcr 9 Q«mocndng JOB IIESCRIPTION
with Seetisn](10n)ot Division 3 oflM Basine,and Pmfiescims Cork.cold my l icense is RESIDENTIAL:
WOO FlHihtl'I'ISSUANCE
l-�- in full force attl eDeel. ❑SIl)WL ❑KITCHEN RE51001J.
aFU�j License CTas, Lie# APPLIANCI--S-RESIDENfI A[, ❑ADDH ON E]1'I,UMBING RE-PIPE
NGC Dorm
ARCIII'1'IiCTQS DELIEChARAI'ION ❑MULH-UNIT ❑STRUCI'URAI,
~o=Z I wdvwnd my PLw chill be usedas public meoxds PANELS MODIFICATION
UPTO200Ah1PS ❑INTERIOR OCH[MNEYREPAIR
F'LLI Ucrnsed Prufcssoe.l 201-1000AMPS IMPROVEMENT. E]SWIMMING POOLS
OWNER-BUILDER DICCLARA'HON )VI:R IiXXIAMPS ❑HATH K EMODFiJBEIAIR ❑DFMOLFION
a Q I bereby uffnn IMI I nm Uxcnlpl from IM1e Cmeaaorn Leerew Law for IFC
W
3 LL U follm neo Teem..(Sauces)0313.Brain, it Irofcssion Cock:Any city or clwmy SIGNS ELECTRICAL ❑OTHER
,I-a which rtgmres a permit to asnstmct..her,improIkma
ve, lish,on 11c it any stmamrt
t'LLOJ prilnl I. 1 tequ the ,liceIf hpermill f1 signed Nanmem SPECIALCIRCUFAIISC.
yy that e.:I' dP to]bey ': t ftM1 C I lam. I- Law(Cnapler9
w a'pCOMMERCIAL:
IY team a iacx,w th Ni fro 7000)orDlvisi«or t flhs H 9m3 d 14 f. ions CLL:)« ']'EMI'.METER Ok Iltl.l?]NST.
6 dx e On' ION
Inas he is 31 5 b Irby aM]i and IM avers for he cs ribe (rearm.n.Any violation y o �,I ❑NEW BLDG/AUDITION ❑FOODSDEMOLRVI
Way Section'RUI.SM'x^Y.pdoll Rrepelmil.whjecls the glplieammacivil perliltyof POWER DI:VIC 'Ia� TENANT ❑I-0005FRVICI:
cot mus:tan Bvc hunched eollars IS5fX11. IMPROVF,d1ENT
S$SD ❑ Lmcowncrofllx:po,,Vrq.orrq oT1vyc,,with wage..slhdrwdccompmuntie , SWIM NO )OLPLECIRIC
wi 11 do e work anal die smi mm is notterm «
edottcrtd Ger u1c(.Sec.TA4.Ifwilllnz ❑f)'1'I II?H
th
W 3 m and ProlCny.Cole:The Curnmemr.5 License Irw me,not apply to w owner d' OUTL (THIS-FIKTURES
prl.pen) M hu'W w .'Pro .Ihemn and M Ih.sueM1ork brimelf or n.,h .
his own cerloyce,pro dN IMI such i pm t x bbc dtcrtd fin N12W RESIDE.— SQ FE
salo.lithChLlilding(,riiiipnwntldwithyeiLrofplctit,n,iM Sf IT.[l,(N)R RIiA SISQ,IT
nw bulake ''11 rase me bunk fproving IM1t he&dtel build - ,Ac ter Pur
pore f,de') D.
1,sex amino of the prupmny,an e5cluMSC1y conlraci nR w Ih Ihcelued(glaaClnrs to TOTAL:
constmm Bit M*t ISCe,7(W.Husircss aM Pooli,ssians C«Ie:)The CnnlraClnrs la- ��I[sf�I
mI, ,,,not npply r.re,,ner of prt,m ywho beileb—ihmxovw ten.m,and QTY, PLUM I P MI9' FEE JUL O lIIW u
who,"J1,f«stwh pm}RIn wllhuamlNCl«Tel l'nanrcd lwrxmnun ten Gmtracmds U u
u'.law, ' PERMIT ISSUANCIi \
❑I sen e'emlu umlc,Sn. ,B&PC for this revue - _
OwnerALTER-DRALN .--WATIi A)
Owner yea Yt .
. WORKERS COMPENSA'I ION DECLARATION BACK[q.UW PKOILC. �.Y
I hemby uffml andi penally Mperjery emem to folltwing declarm. ;�C.GROUP
❑]have certwill maiwin.CrnifnwoulCmamwsdf-iruum f«W'Mers C«npen- DRAINS-FLOOR,RIX)II.AR.. OND. IFS EAEIN
xation,as provided lie by Sectim 3700 of the labor Code,fur tM po ear c of thewntA fr x'heb Ibis pannh is i.,o,d11%TURES-PLR TNA]'I naveaced willnfi nam Wnrtds Cnmpenaaian]mar we,u ivmred by Seaborn
3YWof the has Cldc.tar J,,pedisabac.f ere work fur which lhivpereur isrsted. GAS-EA.SYSTENI-I INC.d 01rfL.'
My Workers C«npenxaton l..c amnio aml Polity comber see:
Carder. Rtky No.: GAS-E.A.SYSTEM-OVER J(EA)
CIIRTIh[CATE OP IiKEMPf1ON]-ROM WORKERS' GRI?ASI%INDUSI'RI.WASf1:INFERCHITOK
COMPENIA'HON INSURANCE IlU .) ]VISION ITES
Oris u'CIilN nminu he clmtpinnl if to prnnilH❑mom hurdreldNlan H1W) GREASE TRAP
m kas) PfANCIIECK
Innify that in IM1e Mrfommaaeo{the wort Grwhkb Nis permit is issueJ,lahill / SENER-SANITARY'-STORM EA.200 FT Q
not anploy any hereon In any nemb er o as to becomexuh ecl In Ise Workers Cnmpen- • BNIiRGY Ill
0 ,7, Lminn laws of California,trate WAFER]]IWTIR WIVENTILLECIB GRADING ItiE
Z Applkvm
(n NODCE TO APPLICANT:If,alter making this Cenifinl.of ESemgilsm pm MrvM WATER Sl'SIPhME%TING
a ; hccouc sulssc m the WC e,Core,ewallun firoymons of Ibe Luber Code,yw must
SOILS IIHi
W hmhwnhaimMy with,uchp ,,i...ns«thisterm,stall he dvermil mvokul. WATER SERVICE
a CONSTRUCTION LENDING AGENCY NEW'HESIUF.NTIAI.PLMN. SQ.IsI'. PAID Dae RacigN
1 h.rtby afrml than miss,is a cwrm
zctom keiling agency f«the perfnrrruae of
LL -a to wort for which this perut is cinaed len.3097,Cm C.)
Q U Lerylcr's Name TOTAL:
1<nl.r's Address TCBAL:
fy. y 1 waif,Ban I Faye reed this application analxWr Lha the al.me infomuti.is GILDIN<i 1}'E.
LN cllmet l.grrememmply.iN all city ort crusty wliwrcaerW snare Ewe rtbting to QTY_ MECHANICAL FERN1IT E SEISMIC hYF.
UZ Wiliingcerronfiob.and hereby.mlxxizC rtprewmatisxs Of ibis city m enterupas the _ l
N,,ne,micr 1p Tey forinnpeetiun purpxes. PERMIT ISSUANCE -E70 ELECBIC ITE
(We)agtce males ilxlemnify ad knp nnntdc,..me city nrcalndil�t agars 7�
liabiliticsjudghrcmv.cmu.ml cxperua which nuy inwy way attrne,airst said City ALTERORADDTOMECH. PLUMBING FEE
in cnllsryuen i of the,gneriog of this permit.
APPLICANT UNDERS ILI,COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.100 CIM)
SOI/RCI3 EGULATII NS. MECIIANICAh FTI! �
AIR HAMBLING UNI'I(OVER III,IXXI C17VB CONSTRUCTION TAX
vote of ApplicanVConvma 1 le EXHAUST HOOD(WMUCO HOUSING MITIGATION FEE
I' IAIS DISCLOSURE
Will Incnppliaam«form rbilding lnoulshm x0m mbndlo hmarcbuv eel-] HPA'ITNC,UNIT('1011XI,1XXI BTU)
u defined by Ina Ca,rheyt Municipal Coca,Chaplcr 9.12,and IM Haman ami ImeL,
Cbd,.SCcuan 255321x)' HEATING UNIT(OVER 100.000 H'fU)
Ya PAID
VENTILATION FAN(SINGIED) Ih¢ RacipN
•
Will IhC applicam nr Torre building lcuupum u.m cyuipnrm«dcvinz which
emit bean avtoax air cobecoirams ase loaned by IIIc Hay Acca Air Q.111y M.w enyenl HOILEH-COM]'ERIII.D�)U
D\Di.mell HOILIiR-COMP❑Yc.
I Mvc ice du krzoleas manurial,myabenn-Ins ami CTwpllc 6.95 of me Coli- AIR CONDITIONISS UA. ;DATF_forma IIk:dlh&MYcly CI 25513 send 253M. urda>5red N:II it'theNEW RISIDENTI
Widin urrtntly Mvcakrhw.tut it hn
-thirty it)beity to wer,cam
erilicim
IOwhx. 'r.V u¢n Dal TOTAL: ISSUED BY:
OFFICE