S0037 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OP'CUPRRTINO HUILIIINGRhN,CTRICAL PERMIT NO. n
NUI OFCDING DIVISION APPLICATIONIPERMIT PLUMBING.MECIIANIGM. �fylu�
BUILDING PROJECT IDENTIFICATION �YAJ
_BUILDING ADDRESS:
jNM%RyO. APPLICATION SUBMITTAL DATL
&TL -7
P '& CroR'SN G LIC NO
ZT C
ARCUr'EC'DE dGINHEH:
LIC NO:
CONTACT: PHH/.{ BUILDING PERMIT INFO
J ( [2- ❑ Con ultant Fm Paid by Applicant(Initial) B DO ELECT PLUMB M_CH
/IrJ�1C,� ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
I front afrm]On 1 an]Ba
n,ad miler previsions of chapter 9 ammnwncine JOB DESCRIPTION
�aZ aim Sccdiim7")ofDi,mdn3ofWC Ba,inanmd Pr,[aa,irm,caste,ad my license ie RESIDENTIAL'
LLT O O PERMIT ISSUANCE
F LL[U in full I remxl-11 set ❑SFDWL Ll KITCHEN RESOLE
F ZUI Uma Cmlran« APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PII'I.
N66 ARCHfI'ECTS DECIA T10N ❑h1ULTI-UNIT ❑STRUCTURAL
Z O vOi I udee,rind my plvns,ball d asst u publish PANELS MODIFICATION'
OZ— UPT03W AMPS ❑I ° TOR ❑S IMN EY FOC
F-L,F'-Tal Heated Hofexsiwul all-1000AM15 PROVlih1 SWIMMING POOIS
C ¢ 1 hereby aRtm IhmNCNsUILDER DECLARATION
C ATIONfx Liaise Law f«Be OVER IBEBAh1PS ❑BATH REM OD & VR DEMOLMON
XO OTHER
L U following reeum.(Seek.703 L5.Basin,,cowl R fiesvim+Cuk:Any city ser eeurny SIGNS FA F ICA ❑�
3 LL which require,n permit to ecroauce,where,impose,dereali,h,m tcpur any stmmure
F u'Og prince,it,i..0,pertinent theepplicartforeach permit lis Eldasigrtd slmenicnt SPF ALCI 0' 11.
that be i,licensed p]mmarmthe povi,aom,Tena C,ntmcnw,[it.law(Chzper 9 av
n1a0�0 (mmmcrwing with Sati,n]q)Ul of D,vidWbMthc Bu,imxs and l'rtnfca+i,na Cak)« 'RiMP. ffliR )H POLE 1111 LLLU
d C C that be is cxcmp Ihctefrnm ad the basis for the alleged cacmpliem,Any viMuthn of ❑ I?W BI,D _ Im.MOLTION
I y Seaham 7031.5 by any nWlaewt far o permit anbjcas the-If--'in o clean Amity of POWER DEVICI TP AMI' D SERVICE
>
not mmf than five bumhe n dollar,(S501p. PROVENO-our,,
z^-IQ ❑Lan twner of the parywnYnr my employees with wogcs as lhvir.xdcmmpmsmion, SWIMMING ELECIBIC
1ISS-- will du dw work,and lhcstmcwre is nntmtcn/cJ«o@rad fee mile(Ste.]Bi1.Broin«z OTHER
and Pr,fcu'ions Cone De Conlracer's Licrnm Law dose,not apply ad en owner o EIS-SWITCIIIS-Il%TURIiS
y 3^ pmperty woo builds or impmva then m,and wbo does such wows himself«Ihmugh
his wa enployces,povidrd this inch ampm.1,vow not interxlm«rllcred for NEW RESIDENTIAL ELECTR SQ FT.
sole.If,hart,huilding«improvement u told within one ycur of cmmPRtioo,de SQ,FT.FLOOR AREA SISOhotFT
rcrhuikkr will heave the bunlrn of grooving that hen did mr mild on iminwe f«pn-
pmc of u0.). f
❑1.as owner of the gmperty,am excludvely—ling wain licemee"and"aCfa to
ad .the .jc,(Sec.704J.Best.east Prafe, —LottrO Tee I—wac a Li-
in.law coca,.apply to an owner M propery who build,or impove,ehaean,ed QTY, PI,UMBING PERMIT FEE
who cuntreces for such pmjms wild•cvnitar«(a)liccntud portion tote Contractor's
Li«mc l.aw. NSUANSUAN
O 1 em e¢ntp a da See ,x&1'C for this mato,
RAIN V -WATI:R(EM VALUATION
Owner Date
WOR K Ek S COMPENSATION DECIA NAI'ION W PR Ili EVICEbOI Lerchyathonmukr Penally,fperjuty one oftha follwing nkelumtbn, V'PL(%)H,NIX)f ,CONIJ. STORIES TYPE CONSI'ROM ION
.mtiom,wa prnvidcel f«by S«eion 3]W of Bila Lahr Ode,lr the ,crfnmmnec of thew«k Row which this senna Is issuni -PER'❑ I have ted will maintain Worker,Compcnvtion Iwttarece,us mquirN by Seen-
3]WufthelaborCnd.forTheeserfCrane of the wM for wbich ibex Amnial ed. SYSTF. -I .q QCC.GROUP APN
MyW ao Im tartertare east PoliPolicy No: SYSTENI.OVER JERTIFICATE EXCSIPI'ION FRO OR LE 5' NDU.SfRL WASTE IIs F.P OR
COh11'ENSATION INSURANCE 'IL I UI VISION FEI3
(lldxscma«t nesd«nheecropleW ifde pemue i,f«one buox4eJ Jdlv,ISI W) GREASETRAP
«less.) NANCHF I F.
IcmifY lhm tache prrformmec of thcw«k farwlieh lhisprnnit is hweJ,lshnll SLIVER-SANITARY-STORM EA.200 17..
cattle,troy Person in troyrainier so ant,to ver se subjeet 1u the Wart,,"Creeper, FJ:I?HG F
zZ saeion laws M Calif«nin Date WATER H1ITER WNIiNTfff1J:CfR GRA N ITEE
0 A,lieant
N NOTICE TO APPLICANT:If,after n Mng Ihi,Cenif m of E,n,ce dam,pm should WATER SYS EN✓UREATING
hcmmcwtiect nine W«ka(,Com tion floe lana Cdf you m,H SOILS
r,,t confli nail
W fnnhwith comply with mcM1 provisions«this pcm]it shall he J¢ned mvnAN. WATER SERVICE
Q
CONSTRUCTION LENDING AGENCY NEW RIi51UliMlAL1'I,MIf. SQ,17Lf PAID
vow xcaiptb
U O 1herchy third]thin there is v eanstoetLm lending agency I,,the p:efimnvwe of
w P: the and,for whin Or,'root ie nssud(Sae.NW 'Co.C.) D rAI:
Ictdf,Nano
O LU TOTAL
I<mlcr',Address
1 ccnify that 1 have often this a,,,hcanan and nae Nae the ahrve mfum]mion i, NUII.DI FEE
F-' N c«recl.lagrc locmTly with Al any and educe,«direnea ed more law•«L]ting m QTY MECHANICAL PERMIT SEISMI Ffl!
U z huiJing crbVNCIi«4 east hcrMyauthariu mpe,cnutivcx of Nh city eo rnRx l]prl the
ab,vcmrntbrwd popcny fou in gcceion pup,¢,. PERMIT ISSUANCE ELE6 IC FEE
(We)agree to avec.indemns,and keep burnout the City of Cupanim alai.
liabilitie,,ldgmcncs.cost aster acs which may in any way accrvc'anom said Cary ALTER OR ADD TO MECIL PLUS UNGFEE
c,meq ufntc grmtdnL ,rill. 1
N LIC. UNDO TAND A. D WILL COA1P1.1'WITH AL1,NON-POINT AIR HANDLING UNIT(TO I O.BW CITE)
MSCI ]CAI,ITE
S EGUTATI ,'S.
AIR HANDLING UNIT(OVER 10.00CFF1) CONSTRU ON TAX
ppIn, A, EXHAUS'P HOOD(WA)UC) EOUSINGMI'f 'ATIONFEE
HAZARDOU, fATERIAISD.0 SURE ,
Will enppllcardrfutmch stili,goavlum,tmc harnllchvnNsu,nuucrial HEATING UNIT(II)110f0dI It Ill
vs nkfrcJ h ne:Ce,Vneo Municipal Ode,Cfairder 9.I awl the IleahM1 and Sakay
Cn.lc.4di,n 25511(a)'! III'A'1'ING UNIT(() I"d"'lBUU)
E3 yet _1 No I'AIU --
N VENA LAT ION FAN(SI d.Ii REX'B) Dam RuciPtx
W9llehe applianl«fee—building«cupane ux ecaTerentm drvims which BOILER-COST'(3HP OR lMl,lpH tlTV)
•mate hmatdsua air conwminere,a,tkxnml by the Bey A.Air Qmlity M.R,,roem TOTAL'.
Dinrinp BOILER-COMP(OVERI BTL)
❑Ya ❑No
Ilaase tout the h.^nW�c twefiel"initi eon,ardor Charterh95 d de Cali- AIR CONDITIONER ISSUANCE DATE
f«nia U,aIN R Sate,Cde.Section,25305,25533 and 2553.1.1 udermmd ehm if tk NEW RESIDENTIAL MECH. SQ.FT.
huilAing dere ant rly hssc is ort dtu it is dry ee,pmeihilaty he ramify do neeupsa
of the tcqunmrntu whack must be,mm poor to utterance d a Ccnifwme d Qccalur]cy.
pi—
Ownermeu1lwrazM egrnl Data T ISSUED BY:
OFFICE