S 2446 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTI NO BUILDING-KI,v.CFRICAI, PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECDAN'ICAI. S 2446
HE I LDING PROJECT IDtNfIfIC,\TION
HUILDINGADDRI!.55: ��. SANI'ITRY N(l. nl'PLICAI'ION SUBMI'ITA.)ATE
73S -�- q ---9
r lµ' ERS NAME: I'l l(lNl- C IN'rRACIURS NAMI!: LIC NO'.
o'yD-- NIC COVTR(N.x
�ARCIII'fI:CC/IWGINEER: 1-IC NO: A ❑
CONTACT: PHONE BUILDING PERNH r INFO
❑ Consultant Fina Paid by Applicant(Initial) BIADG tI.EG1NUK MEGA
E] ❑ ❑
LICENSED CON IRACH)R'S DECLARATION Q'ry ELECTRIC PERMIT FEE
I kreny dont mal I am Incensed mxlcr provnioax of Chufacr 9 cmntmarcing JOB DI'SCRIPTION
O�Z wiP Snriw]BBUI nI llavidin Jofde Buaitav surd fhofcasimu Coda and my license is
WOO PERMIT ISSUANCE
F1-. in full lo-a wW cRccl. SIUWI. ❑KITCHEN REMODEL
�U� Lfeme Clan L!ex APPLIANCES-RFSIDEMIAL ❑ADDITION ❑PLUMBING RE-PIPE
F6M IIIc COnaaelnr
l/1co. ARCHITECT'S DECIARAHON ❑MULTIUNIT ❑SIRUCFURAL
PANi:1 S
Z c,on Z I undccaand my plans xiw01 Ic rr J as Pardic«vaxds MODIFICATION
O Z=-1 UPTO 20MAMPS EjINHiR1OR ❑CHL.51NFY REPAIR
FNFw LiccnacJ Pmfasional 201-1100AMPS IMPROS'EMEIST SWIMMING POOPS
p,�j OWNI!R-NI111,DEH UECLARAfIf1N OVER 1000AMPS ❑BAI'll REMODELIREPAR ❑DFMOI,ITION
d 1 hemby affirm than I am esemq fmm'Ina Gnummta LicensC law far the
X3aU falbxingrcmm.ISccEut]1D1.5.Busincaa surd Pmfcaaion,Cock:A,city orccany SIGNS ELECTRICAL []OTHER
ul a which r Vmms a Pcmlil it,amsuun.alar,lmpmsc,dcnnEana or retair any slmnurc
Oprinrmlu irww m
ancv,alyuias Pcapplicanfarsach Permiva lilce �p
, ruuma7
l ncnl SPECIAL CIRCUITAUSC.
P.v lc is lian.d Pwauant In do Pro'kioa,oftk Contractors Heart Law(CliapcC9
IW C) Icommcnciog wiP S¢ni0n)IXOJ of DivinimtSol dw Rusius WPrafnsiom CoticJm TEMP.METER OR POLE IFST. COMMERCIAL
L�k: a that M1a ix aemlp 11-cfnxn and On iris Gx Ilw allcgad oecmPllna.Any onWma of ❑NEW BLDGIADDCTION ❑[)EMOLITION
LL^y Stamm]011.5 by any afgd'n.w fm a paraut suhjecns Pe applicwu m a civil penalty of POWER DEVICES ❑TENANT ❑FOOD SERVICE
{-ZY rot intra than five hunPM dalan($500). IMPROVEMENT
�d Q1,r,wacrnfihc pnrywny,nntrycmplaycc,at wall,,a,nhcirenlc cunpaw(un, SWIMMING POOL ELECTRIC
Sy�F.G will dotk work.am!ikgrucwre is ww mmmffur.N
lcdoroed flc(Sec.90 .Bost— ❑OTIII!R
LL13 Boost—
and!Pr„fcuimz Code:The Cwr ci Idccm.e law discs nes apply m an miner of OUIII:CS-SWRCHFS-tl%T11REs
prtgcny who build,or impmvas Pcrem,and who B,a.wch win{,him,clf ur Pn,ugM1
his awn emNay«,W"aided that such arpn"cmems an,twt iweldeJ sur"!rein]For NEW Rr11)EXI IAL EI,ECIR S'Fr.
We.IL htwxan.tk huithng m infrours Ent is sWJximin are yaarorcmnpknan.me SQ.Fr.FLOOR AREA !`SQ.17.
ustra,,Fairer will have P t hural of proving that ha did not huid m inist-fa Pur-
Pxe,I sonic.).
[3L as axtcr of tk Pntpcnv,wn eo clusnely contracting wim Iicen,ad(exanaCnnn it)
TOTAL
ctm,trvv tk pmjcct(Sec.704,1.Hmircu and Profcuims Coil Tk CnnlrxlM,Li.
.Law dol,mx npMy to an nwrcrofpn,pcny wN)l,dlds or improves llrrcoa aan QTY PLUMBING PERMIT FEE
who mnittin,for such ProjccN with a connaanga)lammed purtuant o tk Cmnmclor'x so ll
Latin.Ux. PERMIT ISSUANCE so
❑I em eeemp ander Sre. .B&P C fur this rcnxm
ALTER-DRAW R V[Nl'-WATER EA) VALUATION
rcr D nc
WURKIIISCOM
ty,,I PSATIOnDF.CIARAvaing HACK FLOW I'R(y1F,CT.DEVICE
handy illfmn wdcr pcnalny of tx jury mu of Ihc.fnlLwlap declaral Co
Inuits,anlwill maimintalion tam of Cusunuo self-inwm Gr Worlds Cam p. DRAINS-Fl.WK,R(K)E ARFl\.GOND. STORMS TYPE CONSTRUCCION
work oar
which this
fn M1y tiled.3]1X1 of Pc Uha Ctdc,far Pc perfmmace of tk
work Gx which mis pitman Ia issued. Il%1 QRES-I'I!R TRAP
❑lfor"and will maiauin a,Paso c aftbiion Irk f-we, h rociothimpred by Salian
My Worcr Jahnperlgfn Rcpvfor carcnfdac oli fuwbicM1 Pispmnit is i.asusl. GAS-E,\.SYSfG\1-I INC.a OUTF'S OCC GROUP APF
My icr: Cumpmwtim Bawrame carrier and PNiry number a.:
Cnnicr: Policy Na.: GAS-EA.SYS'I'UM-OVER d[L'A)
CER TIICATE OF"FAM'ION FROM WORKERS'
COMPIWSATION INSURANCE GREASMNDU.S RL WASTE INTERCEPTOR
BUILDING DIVISION FENS
Ill.vxniun teal an,hmmplclN ifdcpnnit 1,IixmcM1undmJ data.($IqU GREASE TRAV
nrlaas) PLAN KFEE
tato(,Per is Pe anynrena afllcwnkfor xfiich Pispermilrkar,Corofshall Sliµ'I!R-SANfIARY-STIHM 15.2W F1'.
.play nnypm wtyn t¢r so d,m M�mnse aubj,cimPe WxNcrJ Cnmisn. IiN1iR :H
O Z sato.Uwe orCullinmiu.I}mn WATER HEAT WNPItTX.LECCR D DO
ZO Applicua GRAI G Alin a—,
N NU'flCl?'CO AI'YLICAMI:In aficr making Pis Ccnifivalc of ISwnpinn,you shwlJ WATER SYSDIN/I'REAl'ING SOI ale lvl�i% 1
a ; Iwcnma xuhj-, ,,PCW rkcr's Cmnpcn.wtio 0 nnosi,imto sur nk laho,Gdc,you Pmt
ftxPwiP crxnply want such pmvi,wm m that pcnait shall he deemed mvoknl. NATER SERVICE
0.U _O GUN.S'1RGGIIQN LENDING AGENCY NI?W RV_SIUPNI'IAL 1'LMB. SQ NL 1'AID1Z.l
heahy a0inn tAa mare as u amwrucuoa land ng agency for do,Pcrfmtwne at �) x
tk wast forwhich oris lcrtait is issuN I.Scc.3(19],Ci,C.)
1<tdcrs No. S6 TOTAL:
r y I amity dun 1 hava mad this application and stale than Pe.Bnve infuution ais BUILDING FEF,
nFi (A col-un.I agra m comply with all city and wanly arditwuacs and sham law,rdaing e, QTY. MECHANICAL PERMIT FEE
U ZZ building cmutractiaaa and lwmhy amhorim rabmemmivc,,o Pis city mens upn the SEISMIC FEE
aavc-netuintN lxapcny fur inspection Purposes PERMIT ISSUANCE.
(Wa)agra an save,indemnify and keep herrnk.no,City of Cup+tim egaimt IiLECIRIC
FV
iahAilio.jmlFmeno.OmuunA cxry:nrls whish nwyinanyway ucnw:ugmnenwiJCay ALTER GRAUD'TOMECH
antctticam of the ymntin�of Pia pima. PLUMBING Ft
APPLICANTUNDERSTANDS AND WILL COMPLY WITH ALL NON-P01NT AIR HANDLING UNIT ITO 10.000 CFM.
SOURCE:REGULATIONS. MI!CHANICAL II.
AIR HANDLING UND(OVER 10.0010 CFM) CONSTRUCHON TAX
Sigmmrc nfAph"nl/Cuntrunm Dwe EXHAUST HOLD(WNUCn I H IUSINO Mi'I'IGA'I'ION II?I?
IIA%ARDOUS MAIERIAIS DISCLOSURE
Will do,suPplwantm future WilJine mcupuru snort or hendk hvuJaas onarcnial HEATING UNIT(TO 100.0100 BTU)
as dcfircd by tic Cupmim Municipal Ctde.Chap"9.12,and ON,Health and Safety
Csxlc,Sector 25532(a):' HEATING UNIT'(OVER HX),(X0 If FU)
❑Ya CI No VEND[ TION FAN ISI SOLE RESIDIPAID
W dwt'n
-� II n licam insulate MdldinBocaTantuw cywpnwn n w devlccs which Wm Rcccip x
IfOILIiR-CON 11(31 IP OR 10100111TI11
aNn hvmJws air enmaminants v defined by for Bay Arcot Air Quality M.vwgcmcm TO
1MaO
rncR BOILER-COMP(OVER 110.010 BTU)
❑5'cs C]No
I have mad the hanilnr,rtoc+ials myuitmcns under CTatDar 6.95 of Pe Cali- AIR CONDITIONER ISSUANCE DATE
Onions Hcd i A,Safcvy Cale,Semon,LSI405.25533.1 li!5331.a rsrarxl that ifnk NEV,RRCIOESH(AL MECH. SQ.ET — �T
huiklingrkx, C—Itly havca mnnnt,that aisany¢nptnrihi0nym nmifyt knc,vryot !/]C
tic tk asiauen "which a acr be inn prm
ixiawarxcofaCmidkwc a((karyxy.
rlwncr or aaduar,w vena Data i cTAL: ISSUED BY,
OFFICE