S 0299 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPN RTINO BUILDING-F.I.NCTRICAL PERMIT NO-
BUILDINGDIVISION• APPLICATIONIPERMIT PLUMBING-MECIIANICAI. (N 029[]
BUILDING PROJECT IDY.M'IFICATION J
BUILDING ADDRESS: SANITARY NE:
O. APPLICATION SUBMITTAL DAT
/9735- bfZRkC DR . 177 1
OWNER'S NAME PIIONI_ pp CONTNACfOR:S NIc CONI NAME: �OHS'LICNO:
• o2S7C/AL/391 l<oLN
iAR 11'fECT/PNGINIiIiR: LIC NO: ADDRILSS: ❑
CONTACT: PHONE: dU ILDING PERMIT INFO
7Vf1-iv 37 Consultant Fees Paid by Appiiw t(Inifial) ELECT PLUMB MECH
!—\
LICENSED CONTRACTORS bousisse, 'I hap Q'I'Y. ELECTRIC PERMIT FEE JOB DESCRIPTION
Section
vlfvm that amI da,Bumdtrpmvt.itx..of ClwPa 9!my It,,neseg
ODO in full
ID001nfDiviaiun Jnflhc❑usirxz.and Pmfcuinm Gdc.and my Bansis PERMIT ISSUANCE RESIDENTIAL:
to full Twee mW cRctt -083 ❑SFDWL ❑KITCHIlJ RI:h1DIlEL
t Licrns Cl _ hicN I APPLIANCES-RESIDENTIAL [I ADDITION C1 PLUMBING RE-PIPE.
,<i Zw Dam T'S Del El MULTI-UNIT ❑STRUCNRAL
FOy ARCIfTECTS DECLARATION PANELS
Z lumkntmd my Plea shall bcuscl ax public records CHIMNEY
REP
OTION
ZO I1PIY12alAMlS [I INTERIOR ❑CIIIMNh:Y RI3AIR
F.r?Fu1 IJcensd Ptofe,simtal 2(11-1000AMPS 1 PROVEMENT ❑SWIMMINGPOOIS
OWNER-BUILDER DECLARATION OVERIWOAM ATHUAODFJ/REPAIR ❑DEMOLITION
C'�y�W1 Q 1 M1ertby elliml IM1aI l am as from Ile Chhv chars Liana law'fw the
X 3 L U follwivg arson.(Section]NIL Burihl s and Profcaions Cock'.Any city«untnty SIGNS ELECI)UCAL ❑ HER
which requite a Irnnit to cottwuct,alter.inufmaie,demolish,«repair any smaclum
F-LLO Pi«tui¢iuumwe.do tequila,ueapplicml for such palmil to flex sigwl.ne—i SPECIALCIRCURIMISC.
Ilmt be is licenwdpursuant mthe pro,sion—f the Conttxux'a license law(CluMer 9 OMM R .TAI:
I+IypO (amm,,sjbg wish Secom7010)of Division J adze Busmen and!PmfeWom Code)ne 'OMP.MLRER OR nRR INS,
ay ey tit he is excmq theoefrom uml the basis G.ife,alleged excmptmn.Any violation of ❑NEW BLD(1IADDI1 ION ❑DEMOLITION
x_N Section 70313 by any applicant rw a permit whjecls the oPPlicnnt to v civil Penally aT POWER DEVICES ❑TENANT ❑FOOD SERVICE
W n ra then five hotdred dollars(5510). IMPROVEMENT
FZQ O moI.-.,a the prupeny.or on,eandoym wita wages as their wk rompemaak,o. SWIMMING POOL ELECTRIC
C will doille,,6.00d lhcxtmcture is not imm�ded,,oRlsd forwle(S¢.](1W,Bosineu El OTHER
and Pinfie a ams Code:The Common's License law duan m aPliy man malar of OlIT1.EIS-SWICIiFS-FlXTURFS
6 3 i mpeny whr build,m impruves derma,ural who does such work hinweif or through NEN'RF_SIDFNf1A1.ELECTS SQ FT.
hies own employee.Pmidtd Bad such ho,owmem,me.itueMed m uffaed f«
see.If,however.the hmlding(r imPn^'en<nl is aid within wte yeartl completion,th SQ.F1'.FLOOR AREA FI'.
StSQ.
er-huilder will have tine hurden of moving that be did tax build or improse f«Por- /i
P n p I D
Poeasale.). T
❑ 1,ev twnar of Inc pmpaty,am exclu.sisely contracting with Ilamcd emtmc(xx to
.t Ne feet(Sac.]IW.Basin..eN Pmfcvvwts I.:)The Contacamr L.i- •�
,io,law dies mx apply m:m owruropommy w
f hw o KANN lfnn�on,and Y.QTPLUMBING PERMIT JUL 15 �FD
whoamnacmf«abeh Projmaxithacomeact(s)BOan l pltrsrumlutlnaC--lax
L.emc low. ,B&PCT«Thi,rtawn PERMIT ISSUANCE TTI
E] l am cacmtx utulef Sec.
ALTER-DRAIN&VENT-WATER IES) ION/
Owner Dale
WORKCrpS ly PENSA'f10N 0fiI fQlhminN HACK FLOW PROTECT.DEVICE O
1 M1amby alarm aper penalty of Perjury me of the mium ing declanTs Ch
nm,ah andw'ill ful by
of the Le to serfs,foimf er-bo ea Compcm IlRA1N5-FLWR.BOOR AREA.CONU. ST(IRIF'_ti T\'PE CONSTifUITO?
.alarm,ua which
his
fur by Seclim J]f10 of the labs Glc,fur the Performmec of IM1c
01 have
which this permiti.orA. IIXNRES-P[R TRAP
❑ IM1aveend will iodi,fain Wuntcrx Cump Ofw vv Inwee which is Pemhi Section
J]OOof the lalw CWe.f«The pmH«rtte�nJcatc of the wah fee which Otis lermil i,ivaN. GAS-EA.SY.STEM-I INC.JOlII1.ETS (KC.GROUP APN
MyVouksSn Iinl ;aW cPniky Noy ' ary—� GAS-EA.Sy%M?M.OVER a(HA)
// t " 7J O Y 6 �/�
CESTIFlCATECIt EXHMPHON IROMWORKERS' GREASFIINDUSIRI.WASTE INTERCEPTOR COMPENSATION INSURANCE BUILDING DIVISION Fl±ES
1'OEx section naJ not be eomplcc I.fde pemtit'a fwtmc humbcdallms(S Bid) GREASE TRAP
«kx,.l PLANCHFEB.
PLK IF
Icenifylhminlheperhtmwmcaflhcwwitor hichthii emit Lsluuad.lshall SEWER-SANITARY-STORM EA.NIU Ff,
eat cmlioy any,'.in any..w m m he me wbjec(mA
the Wnm'Compcn- IIiERGY IEE
Z aaai.Lowof Califomia Date WATER BEATER WNENDELECDt GRADING LEI±
Z s
O ApElheam
NOTICE TO APPLICANT:If,afar ma call Thi.Caafi me of Eacmlxion,you ahnMl WATER SI:SH; I EATING
n ous FlaE
a 7 femme,cmcpm rbc Wnd poo Cumpcnwhis nmvivinnx of the Ulomod! Code you nmol
fmhwiOt comply with such Povixiwamlhis Pamir shall4 deemN revoked. WATER SERVICE
aQ
CON r 'IONLPliDINGAGENCY NEW RFSIDENIIAh PCMB, SQ,FT. PAID
UQ Ihachy dBrmmtham Ncrt iis samry
conclinn lending ugcrcytir Oe performan<cof Ualc Bccmiptp
D. I~ the wort for which Orio,permit is issued(Sae.San,Civ.C.7
U Tanker's Name Tl1TA
O {Ll Iemkt'x AtMreu TOTAL:
y 1 cWdy dem 1 have amid this.,Iic�tim and alma that the atn,c inhrreat ion is tlUTLDING Fl:I;
h cornea.I ogreswe�m�ly with all chy uM arenty nNinuncex and ileac lows rdmiig h. QTY. MECHANICAI.PERMIT FEE SEISMIC FEE
U ',Z Widingcvnst.th,and hcrthy auffeeice rtpcwwti vies hio 4 tcity to cola tion Oe
lNus,—mi tied pommy fir inapccliun ports., PERMIT ISSUANCE
(Wit)agln to save,iatdemnify"tap M1mmlcu tk City of CupaOtto against IH.ECTRIC FTE
liahililic�judgnumr,cmlx and upcne.which ntuy inwywuyoccmcagalmiwiJCty ALTERORADDTOAIECH. PLUMBING FEE
in amsqunte<of the gnmtini of this pentim.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT G`010.000 CFM) MECHANICAL FEE
SOURCE REGULATIONS,
AIR HANDLING UNIT(OVER 10,000 CRU CONSTRUCTION TAX
Sigmwa of ApplkmVContrvctor Dab, EXHAUST HOOD(W/DUCp HOUSING MHTGATION FEE
HA]ARDOUS MATERIALS DISCLOSURI?
WII Neappliconl a fultue building occvpem,mte or handle harart maanal HEATING UNIT(TO 100.000 BTU)
as dcfned by the Cuteninu Municipal Cock,CImP«9.12 and the Health and Safety
Cude.Semon 2553200? BEATING UNIT(OVER I00,0ID Bl V)
❑Ya E]No VENTILATION FAN(SINGLE RFSID) PAID Date RaciPN
Will the appliumo or tmwe Wilding iwcupant u¢mit eyuipnatm xr dmeicen which BOILER OIIP OR Ia).(p0 BTU)
eba mdoas air c..... dermad by do,Bay Ne.Air Qwlily himagemrnt 'TOTAL:
District! BOILER-COMP IOV ER 100.000E TUI
❑Yc. 0N
I have read the ha.atddmn mmedels rtgtuvamema uwkr Chapter 695 oflh Cull- AIR CONDITIONER ISSUANCE DATE
formal Health R Safay Code,Sectiom 255115.25533 ord 2554.1 utdelatard dad if Oe NEW RESIDENTIAL.MECH. SQ.IT.
building cares not currently hove a Icnant,that It is my lo mxify the«emum
MOeboacia tiffamsnbemel to isyy'� AaCanftaaofOmPency.
.GuaA/rFti '•]—/5--97
parer«nut Magmt ��� aa TOT'AI_ ISSUED BY
XP
OFFICE