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HomeMy WebLinkAbout28101 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPF,RTINO BUILDING-1,11.1A RICA], PERMf r NO BUILDING DIVISION APPLICATION/PERMIT PLUMB ROJECIMECHANICAL FICA 2 O a� 0 a� _ I IIWLDIN(.PNO.IEI]'1'IUI:N'1'IFIGYMON I o1 1 IBUILDING ADDRESS. `Z (A4.JA ON D 10TH SANITARY NO APPLICAT ION SUBMITTAL DA7 L952, F. RS NAME' ] PHONE. N'IRACTOR'S NAME' LIC f / NIC it COAT _iM RCIIITECf/I:NGINI?ER: I.FFIiiC��N��''D�� J ,/] S© c _ /I � ��� CONTACT^. P(j'p1 sl6V�t� NC E I //II�ir\r/"tIIIE ON f� �/ (/!�/ /err '.-/1. ELECTRIC PERMIT FEE �@q�f�I�:C BU .DINGPERMIT INFO �- c O • EL 6HEA s,IX ` PERMIT ISSUANCE. � � —s I.G ELECT' P UL MIE M LICENSED CONTRACTOR'S DECLARAI]ON APPLIANCIS-R131UiiNT1AL - —_ - 100 DESCRIPTION CICZ I hereby infirm that l um bnmed under provisiamot Chourr91cnmmeneng war WOO S,,-,,IV 1of Drvrs;on 3 ofthe RusmessvnJlProfessssors Cale,and my because is in PANELS qV sa,,cltcc�V—"V^''—Iae.11 Z91 R I ] ' FQy ur T02on Soma fff Ili vvv YYY""' m'a m comme� 1201-INBAMPS OZ-MI understand my plan,shell)homed asrCbl�io rec.ohiN OVER 1000 AMPS I SQ ET AREA E/SQ IT Oz—o Qm W SIGN513LEC1'RICAf. I Lmenwd Pmlmann.;l �y 6 OWNER-BUIIDLLrJJ�4'OECIA 'PION SPECIAL CIRCOI9'/MISC. Vi© ^ is 06U I hereby nitiim that I um eze pt<n,an the Col ructora License Law for the Y •/TIT\• W'3Wy followingmnon.(Seaion]031.5 a.-s'.nd Pr.fessms CcAc:Anyci;yorcc,uniy TEh1I`.MET ER QR POLL INST CP,Oj which reymresapennnmrn rucl,alter,improve,de ,Inh,orreptranystructure 2 }2 priormns issuance,sets ymres Flier apphcan fur such ire nmfle ueigneJ Smmmeni lX3W1iR DEVICES p'Q p Nai he ni license resent rn the prnv;smns ul the Cam toe,License Lose)Chapter - 'nXOL' 91cmm,mn wnh Sec, , 7000)nf Divamn3nf the llu Seas and l4ofessiensCMe) SWIMMING POOP.ELECTRIC VALUATION W rich sexes, uhercfrum and the beau fnr the otter J empnon Any vmlabnn of W_vt ip ge /'y'f��,� ell cr- V� f..Za Seel n]1131.5 by any appbcvm fnrepermn wbledsthco Iianrroaeivideraltyur ✓\IL✓"-ETS-SWITCHU -FIXTURES �a I �Yq o me than five hundred dollars - I C m [ I,mownernfllicM rty,ormyemployceswill,wages Iheirsolecompern.lam NEW RESIDIiNT1AL ELECIA _SQL STORIES TYPE CONSTRUCT ION a3_ wi ldn the worn,anA lheswcmreisnaumm�Jedondfe..dfo tdc(Sm.IBW.Business J Professions Cale:The Coulraea's License Law does t apply m tin owner of of nenywhobmldsammprovesthereon, hodoessuchwokh,mulfanhroughl m,,employeeaprovidedtbuls him ro eme arenotmlend dondfewillorsule.IL {7/ _ OCC GROUP RES.UNITS 1 meglhebulldmgortMmv em oldwnhmoneyearof omplehon,theowner- m IJer will heve the hu in It That he did not bmld nn prove for purpose of sal ')' IQTY.I PLUMBING PERMIT FEE I ILOODZONE APN [ Leaowner ie mna,ttlusively amUncb nhl ensed cnntmnnnm nn over Ill c.]041.Business and essions Cod:)The Comment's Lot se Law upplyto.c ownerof nywhobuildsn i owaslhercon,anJ PERMIT ISSUANCE who nm=owsfor a prolectswith vacmr(p licensed putsuao mthe Comore ea w� Lore se Law I ALTER-DRAIN&VENT-WAIIF(FA) ""7 f�"T�1 FEESUMMARY ❑ om exempt under 5 B&P C for this rtmon I ��/ I SANITARY OI1TY 111.FEES N [JACK PLOW PROTECT.DEVICE s Ow­_ Due _i DRAINS-ILpOR,ROAREA,CONE). RECEIJvf# _, �'DRKhAN COMPINSA'1'ION DFCLANA' 0 SCHOOLTAX Y N _ ,a ❑ 1 from that l hove o eenificdle nfromenno self-insure,ors renifcate of FIXTURES-P TRAP' RI?CEIPfk W Aen'Cnmpensatinn lnsumnce oracendiN u,py NeioflScc ltl(10,l.ub C.)whuh �� PARK FEE N vers all employee's under this perms - GAS-IiA.SY TF INC,d OUTLETS b -N---Policy If , ! � But Co.,. - (OAS-FA SY It (FA7 CHEC ^❑ Cenifietl copy i.herby furnishaL M�i ,,n division GftiiASFIINDUSTRL W) RC�fOR GRADIN CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETW �a SOILSPEE COMPENSATION INSURANCE � ppppqFFFFFTTTTTT' or ladsunion need not be co rmnisforonehundreddollas(Slgl) I (SEWER-SANITARY�S'ithlP� , ENERGY FEE / I � `/- Icenif ythn mloustif rmvnaofthe work for whmhmis permit is Faced,I Mail WATER HURTER W/VENT/ELEC / not employ any Pe,on 'n any ruxure,w as in become oblca m [,a Workers' T - —I PAID nmtio a fC life a Q,irY QM Cn WA9'PR gYSTlinf/I'RI?ATING Data Rea; OO pI10E TOAPPLI meAmg the Cemficvm of Gxempnon,you should NEW RESIDENy'IALPI-M13 SQ F3', TO L. a l becmnesublecnn lire WnrAcr'x Cnmpensacnn pros;vnns of the Laden Cale,ycannot � , fonhwnh comply with such pmvimons onhis permit slmll IN,Jeemei revoked. I I BUILDING PEP. �. W Q Ibcrcby infirm lCONSTRUQHONULENDING A�GENCy far the performance of I (SEISMIC FEE Othe work for which this No .is nsued(Sec 3097,Cie.C) I F.LEC'1'RIC PEG ' 7 Lender'.nny, PLUMBING FEE Q F Landefa Add., (QTY. MECHANICAL PERMIT I FEE U 1 certify ihm I have read this aPPM1Cmnm and lime tutu the above infomimian is W correct.Ise mcamI th allrn dcaum Ninances wd nme lawsrelvtin m ` PERMIT ISSUANCE V'1 1 1 � MEC11ANICALFEE Uom grey pyhe yvn yo 6 ""1 lr�l� _ h abov commetrummgartyfre relocation lo purprcumativcs ofthisary mcnter upon the r CONS}'RUCI'IONTAX U adw We)done pmpcnyfonquyear purposes `IAL'1 OR OR ADD TO MECI I. r ( �• (We)ague nt save,indemnify noel keep hunnless the Cary of Cupemno ngamst _ ImbibncsJUdgmems.rose expenses which may in any way sccroeagvinsl avid Ciry C AIR HANDLING UNI'I'(TO IO,IXXI CI'A1) t 1 mcnm rycnw of Om gmm cold,a permm AIR HANDLING ON I'I'(OVI?R 1d.0Pp CFMI vl� ///fC'1YL Y— � — ignat a Apph ucnnlma nr oae '' exunusr HOOD IwmuC.n PAID HAZARDOUS MATERIALS DISCLOSURE , HEATING UNIT(TO 100.000 B'I'U) l `.,— Date RuaptN Will de uppbe;mt or future budding occupant stare or handle hazardous material as defined by the Convention Marierpol Code,Chapter 9.12,and the HeAhund Safety HEATING UNIT(OVER 10f1(ton BTU) TOTAL Cole,Seutmn 25532001^. VF.N'I'ILAI'ION FAN(SINGLE RIiSIDI El Yes El No Will NeappliranmrfmurcbuJdmgoccupanmsecqu ipmem ordeviceswhmh emit BOILER-COMP(31 IF OR 100,00D B"1'Of ISSUANCE DATE reactions air commnmums as defined by the Be,Area Air Quality Management I BOILER-COMP(OVER 10011(1(1 BTU) Ocarract? PAID ❑Yea ❑No NEW RESIDENTIAL MECI( SQ.PI'. I al� I have rend the hvardnus materials requirements under Chapter 695 of the I J p 19 Cubfomia 11mlth&Safely Cale.Seerione 25505,25533 and 25534 l undenwnd llmt �s �- tithe hull of he requirements which must bar mhmnir my issuance ny tonmdy the / L occupeni of the rcymremena which must M met poor to usvance of u Cmidcam of � h ! Orcuwncy I / _ *VC) Owner it,emhoneed agent Dote ( 0I Ii / ISSUED BY OFFICE