S1296 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPEIrEINO BUILDING-ELE17TRICAL 1'Ii IT NO
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL 1296
RUILDING PROJECT B)EYIFIGTION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE.
10 Ol N . rJ 2.ol> A
OWNER'S NAaMI�i:C PHONE, COMTlAMCfORS NAML UC NO
.AHC IkwwIrN r-r_ LIC NO: A3HRSS: I �I SIC COFIROLN
CONTACP.. PHONE, BUILDING PERMIT INNO
❑ Consultant Fees Paid by Applicant(initial) BLD{. ELE PLUMB MECH
LICENSEE)CONTRACION:S DECI.ARA'I'ION QTY ELECTRIC PERMIT FEE ,lrlY��l
I Thereby admit that I em deemed Imdur pnwisions of Chapher d(commencing oftJOB DESCRIVI'ION
O�Z ilb Ssc6on70Wlaf Di,i.,iun3 efth,Busircu and Rofesxianc Cade.aml my Eians is KESIPEYTIA
LL100 wl PERMIT ISSUANCIi
��� mfidlfma aril cRm. ❑SI'DWL ❑KITCHEN KI?110DE1,
aU�j hium.¢Cluo Liu.N APPLIANCES-RESIDENTIAL AUDIT[ON ❑PLUMBING RE-PIPE!
Z W Dmc Cmtmctor
0 MULTI-UNIT ❑STRUCTURAL
F-D y ARCHITECTS DECL\RATION PANELS MODIFICATION
v�Z I urderxturd my plan.hell he e,ed ed
as rohli"ecc
CZ-OUP TO 300 AMPS ❑INTERIOR ❑CHIMNEY REPAIR
F.~LL1 usemwd Fortiori.[ 301-1000AMPS FIPROVEr1FNT 0SWIMMING POOLS
Y OWNER-BUILDER DECLARATION OVER Ilxp AMPS ❑BATH RI?MODFJJRFPAIR ❑DEMOLITION
C W Q I hereby affiml that 1 am exempt from the Contractor's Gecnw law for IM1c
appxS O a U following nnsn,fSatlowl 70315,(foxiness unJ I'ntfessinm Cale:Any city or counly SIGNS I!I.ECFRICAL ❑OTHER
I_! 1: F which,.quirt.a .irF ne cares deet,alter,impose,demolish, fi repair any structure
I"'1=-O� (nirx to its isw.m.al.su requites the uppliemllfa such permit to EkauBne"l uvemrnl tiPF.CIAI,CIRCUR/AfISC.
4 ¢ that heirlicv edpvry anftudnpnrvisionxoftMComtracnr's Gccnslaw(Clapar9
COMMERCIAL:
OD Icnllme.,,ith Scerunt 9f11X1)nf Uiviniun3ol'IM Business rail ltrdcxsirms Clwkln 'llihllt Ml?TER OR Ia)LE INti I'.
a a e that M ks cwmpt Ihaefnxn aril the tads em 0r ulkgN escmpion.Any Imluiun of ❑NEW BI.UGIAUDITION ❑DEMOLITION
MS non 70315 by any vmmlkvll for a permit subjects the.pplicenno a cisil penalty,of POWER D1tsFCES 'NANf ❑FOOD ShRVICE
FC not more!tan five hundred tkdlen(S51p). I, PROVEMI?NT
2F�
1.as mvtrr the of pmlroy,or my nnployces w do wages asthcir sole nxtrpnwtirm, SWIMMING POOL HI.1!CIRIG
will Jn the work,and the ,me Ls rat intmdrsl or oRered for.wle(Sec.71B.". OT
f,BuHER
!Wil' vml RMecdons Cowk:the Comlraclrx's Licrn.s law dura nw apply In an avrcr of OD FTS-SWITCHES-FICI'URFS
c'3 plrpeny who hui U,l rw improves drcrdm,and who loco ouch work himalf or thnwtgh
hl,own cmployecs,mistral!tial-,h intpmvcnrnlz wa not imendtd m offered fol NEW HESIUIiNi'IAI,ELECIA SQ IT,
sale.ILh wevec the BollJEng ow immnwenxm is wlJ wi0lin ole year of compktion.IM1c SV 14.FLOOR AREA USQ.Ff.
'rcr-tviWer will haoe the hmkn M pa^'in8 rut h did Int build er impore fa par- boo#
pose of sale 1. boo#
[:] I,as owner of the mummy,wo exclusively contracting with licenvN onutmcmra to t
mo.rise project(Sec.7044,Buaircxs and Prreevsiam C1..,The Com,—,V- pp E f1
ons law does not apply m an owrerof property who Bonds or impcoscx tlrnrn
r .and QTY. PLUMBING PERMIT FEF. P A a {J
whoco mctx for such pujects with nmrhaidorts)Ii.xnsed purWant todr Conlmclr'r
LiNn.a Lew. PERMfr ISSUANCE!
i]Iran exempt utder See .B d P C for this,edam
ALTL'K-DRAINd VENT- (EAI FEB 24 VALUATION
Owner Dao,
IO
WORKERiderpCOMPENSAUON DECLARA'T'ION BACK IPW I'R(TIEC'f.IJE i CITY Ul-I I
111erthy atBnn uNcr penalty of perjury nnedlM lullrwing rka'Iwatiara:
❑ora.e.rdwdllmainalncceioo leaf Caosmco Corte,snmfer Woxkc/e Cmor ba DRAINS-FLOOR.ROOF, a.COND. STORIES TYPE CONSTRUCDON
as providthi for by Se.rixl 171X1 of be Intim Code.for the 1w+lumwrcc of the
wruk G✓which(hip maim Ia iswul. NI%'I V RLS-PER'fHPI'
IO
I hase and will maintain Wnkerx Comperuminn Imemrec,n rcduireJ by Smlirm
J700uf111e latex Crile.hr IM1c prrfmmenm oA IM1c wmk fm which this pennil is iswed. GAS-FA,SYS1d F-I 1NC.40 FT. DEC.GROUP
My W do,,Cenpenwtinn Inwmnec conic,and Policy rummer ere:
Carr, Policy Nn: GAS-EA.SYS'fH11d1VER 4 WA)
CERTIFICATE OF MtVIPTION FRONT W'ORKE UY GREASPJENDUSTRL WASTE INTERCEPTOR
COMPENSATION INSURANCE BUILDING DIVISION FEES
("Dr uannnnavd.,... pincJ iflM lrnnii nRoorehunhcd BNlms(5100) GREASIi TRAP
nr lass.) I'IANCIII,CK THE
I eenify dna in mrepeefoawrce of dr work for which an,Kind,is is,i Im.11 SEWER-SANITARY-STORM FA.?(10 FT.
now employ any po'rso^in any manner so as to wO,ie subjccl m rhe W'r✓cenx'Co.,, ENERGY FEE
Z motion law,of California.Data WAI T!R I II!AU!R W'NENTAILEfTR
z2 Aptdicam GRADING ItiI
Z, NOTICE TO APPLICANT:If,after making this Cumfic.s of Exemption,yn r slwwd WATER SYSTENUTREATING
(•-' hcc«rc wbjen m r the Woer's Compewtion porvisia DS 4 ohe ow lahCode.yma or mccSOILS FTE
are)
{ to thwiN cnor,l,wish xoeh provisions of(his panto,.shall be,ken cd mvutrd. WATER SERVICE
0.
O
0. Z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL plof 1, SQ.FT. PAID are Ramis N
u O 1 hencbyteffirm that thre is.cormoti inn kiting agcrcy For rhe lo-fi ran.<N
the work for which this perm t rx isnced(Sec.A0➢,Civ.CI
UUlank,',Nmrr 'Ib'I'AL:
IaNcrs Aoldsv TOTAL:
} 1 crnify ohm 1 have read this ii,hc.dan arta vie dot the im ve informamm is HUILOING r i
F y
"no," Ia",o,omply win,all city and entity ordinance,and pram laws refuting it) Q'I'Y. MECHANICAL PERMIT FEE SITS
Z buiding cowxlmetion.and heresy authorize repr.wmtativa of d,city to enlerulxm the NIC
ehwe-menirmN puTenY fw inspmim puryuscr. IERMIT ISSUANCE: ELECTRIC 'I!
(We)agree to rove,indemnify unit keep harm!,x the City M C.'rIm.against r
Iinhilida,juJgmcmv,co,wts ace cxlrnsc which may in any way wcmc agoima wid City AI.T1:RORADD'IOVU7B' PI.1JIdBIN '!I!
in msedeence of the grunting of this permit.
APPLICANT UNDFJiSL . s COMPL WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.00BUMI MECHANICALF
SOURCE GUI.V10M.
AIR IIANDIANG IINITIOVE IE,WIICITI) CONSTRUCT ION
Sign rtofXmlRi.amtt]mtmclw Uat< EXRAUSTHOODDVAFAJ TI HOUSING MITIGATION 'E
MATERIALS DISCLOSURE
W ill me applicent or tumm huid'mg occupant vory or landlc humNoos material I IFATING UNIT CFD 1009()01 BTU)
m rklinol by the Cupcnimu Municiryll Cole,Chupmr 0.13.and the IIcahn err Safety
Code.Semon 858200^. ((EATING UNIT OVER 100.00t)BTL(
❑Ya VFd DT sTION FAN(SINGLE RF_SID) PAID I},ac R, .h
Will the applicant or totem Bolding occupant use,quipmem or okvic,which BOILER-COMP(3111-OR(011.100 BTU)
emit bamrhmx air RMIIamrNnu m Jcllrad by the Ray Ara Air Qualhy rtamgnrcm TOTAL
Di,,Hcl^ 11"ITER-MoUI OVER 110.1)X(BTU.)
]Vas No
have rod the bacxJun rratmaL AIR CONDITIONER ISSUANCE DATE
reyuisnnvx under CTgrer h.YS of do Celi-
fr ono.F Err R Sdmy Cr ''s".25533 end 3554.1 umkrslsM than if Etc NEW RESIDENTIAL NIECH, SQ.FI'.
11Ui ding Jrrx MXNIT( yhaN:.henw,l,thal nplltl'lly InnrnlfylrCKNpul11
otthere . —1,whmM1 must ts. uoldCcniticalco 0.Np rcy.
Zi
a aulhwisde rn D' a ISSUI!U BY:
OFFICE