99070059 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPF.RTINO BNLDINI:-ELECI'RICAh li M1 rN .
x UI LDI W:DIVISION
AI'PLICATION/PN;RMI'1' PLmIll N;-MECIIANICAI,
" R( BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
O-')"oti Q v boYl --Z
OWNI!K'SN,L>IE: I'IIUVN�Ii:�� as CO R LTT)R'$NAME \ LIC NO'.
Q Ay W o1 v� _CLI NIC - NNI'xoLK
HTEC7DENGINER: I.IC NO: ADDRESS: ❑
CONTACT; PHONE BUILDING PERMIT INFO
15 w - CIO E] Consultant Fees Paid by Applkant(Initial) BO FLECf PLUMB MECII
5U N/
LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT FEE
I hs ehy amrm mw I am Iecnseb undm pvolmong of CTnper 9 h.edma odng JOB DESCRIPTION
wd'Z with Sedo.7000laf Division 3Mlle Hmiucmld Professions Cdde.ond my licen.ve is RESIDENTIAIL
-00 P?RMI'I'ISSUANCE?
a�F In tilll form arN eHMI. ,.�0 'SkA7Z ❑SFDWI. ❑KITCHEN RI?MOUEI,
QUU Data Cl., _ Cronit 13, APPLIANCES-RESIDEMtAI. ❑ADDITION El PLUMBING RI?-1'111!
hUwe-.4—'1.0.CY' —Cnmmdrc
F=y �-�e (ARCIITIECTS UECLARA'f PANELS ❑MULTI-UNrr [I STRUCTURAL
ZOanZ lutatersnnb my plans shallhuspl uc)able s MODIFICATION
OZ-= UP TO'_ AMPS ❑INETRIOR ❑CHIMNEYREPAIR
r Ltw Licari ProfnsiorW 1(1-IBt)AMPS LMPROVE.IFNr El SWIMMING POOLS
1 hcrcAY a(frm IhrIN ver
OWNERmpt-BUILDER
he C mlreomr'.Licrnm Isw for the OVIiR Ipar
AMPS ❑BATH RIdMODI]/REPA1R 0 DES10LRION
K 06 U fallmvine rtozoa(Sttlinn 00J L5,Buainc�s end Profcuirn�GNc:AnY city rr cwnlY IX
SIGNS ELECTRICAL IV ❑OTLER
3 U. which rogwrcs r permit m mn.mal.almL improve,dentr b,a poi,ony viraclute vG-�
�.�..0Q pr're to ita lanae,ruhn rtxluimnthu uPrlicont for xuch penult to rdcaaigned stmcmnd SPITCIALCIRCUITIMISL
d�pd NUIMin liarnvW purwenunlhcpnwisidnsof the Cnnlrauun'v Llcm.aI wlChaper904
1x000 (dvnmareingwith Section WXXpot Divimi.3.fPe Bmitlexrand Profeviom Cde)a 'OJTE.METER OR PULP I 51' L:
COMMERCIA
tMl k ix seem)therefmm and the Iwi.f«1M rlkgul escmpion.Any violation of ❑NEN'BLDG/ADDITION El DEMOLITION
_
Near.70313 by an,applicant for. cru,ablate the epplinnt toe civil pcttvlty of POWER DEVICES
r� na time than live horldrN dollar lS]0o). ❑Th:NANT ❑FOOD SERVICE:
F Z Y IMPROVENIENl
O � 1.nsd vter of the l*oPenYwmYemplgm with u„gcsuthcir Wcewtpe�uatireL SWIMMING POOL ELECTRIC ❑EITHER
will do the wed.and the xruaure is not intcNcd aMfetW To-uk(Sec.IBii.Business
W most Prefessials Code:tore Comttxn✓s License Lav boas not apply to to owroer,of OUTLETS-SWITCH S-FIXTURES
13 proper,wed builds or impnrva.Ilxnurn,ad w110 des,n such ummk himself or duuugh
hit awn employees,provided tlwt such impmverr¢mO am not intended a fhared for NEW RESIDENTIAL HLECIR SQ ET.
sale.N.]oweveLthe MtiIringorintpmvcntem in wld within nm:year ufemnplcllon.the D SV 2M ARIL $^Q I'I'.
rot-Nllldkr r
will have the hallon of prood fiO.thm he did nut ruild a Impnrve for par-
oving •II
int TOTAL.
e,. JUL 2 81999 JI
❑ I,m caner o(tM popery 4m eacluaively cunlrYling with IicetucJ aavacraa m
,,,..t„,..tthemjc
pt(Sea.7(D .Haiun Pro .Code)the Cm
amxi
bea oa am s Li-
tenseLawdpplyan owner 4 poacny wlro holds a irnpmvas thereon,and QTY. PLUMBING PERMIT FEF.
whocauran.forsuch projects with aamlRCldtr(s)licrnscd la.tothe Common ri
Lltsnse Law. PERMIT ISSUANCE B
❑I mm csemp under See. B A P C for Nis reason J
AI.TP.R-DRAIN A VEND-WATER(EA) VALUATION
Owner Date
WORKERS COMPENSATION DECIARFI'ION BACK 11-OW PROTECT.DEVICE
I hereby allimt ur ler picadly of pectry me of W follownig declare
J I have ad will maintain a CerOficat of Cnnscnuo self-usum for Wdatds Campen- DRAINS-FLOOR,ROOP,AREA.COND. STORIES TYPECONSTRUCfION
ew'odm,as provided for by Section 37W of the IaNrr Coda.for be perfnm once of the
wurA foe which this pcmdl is issued. FIXTURES-PER TRAP
❑ I have and will reainain WtMer's ComIaa,atiaa Borrow,n required by Sttlkvn
3701 of the labor Cade.for the pertamerce of the work for which this parnot is issued. GAS-EA.SYSTEM-I INC.J ODU.F:I'S OCC.GROUP rA ) A
MY WwkI trn ruo cortin ad P.licy nu Y4
Cartier. Poky Nt,: i'%aa`�IdDI GAS-EA.SYSTEM-0VERa(FA)
CERTIM AIIIOFEkEMPrIONFROMWORKERS'
COMPENSATION INSURANCE GREASMNDUSTRI.WAST!INTERCEPTOR
BUILDING DIVISION FEES
('Gums dmhead.4 he antplacdhthc)omit is turned hulwrtd dolhers 15100) GREASE'fRAY
nr
less)('Gum
1131?
Iccaifythw In the perhmwmcaflhe wort to which NlXEannit it lsvucd.I hall SEWER-SANITARY-STORM HA.ZIX)Fr.
nrtcmployanypawn in any mance mmewbjmu
tohamenthe Wnkcrd C.,c- ENERGY FEE.
O Z .adder Lnws of Cdifdgm c Dare WATER HEATER WNENTIELECIR GRADING II:E
Z Appicar
h NOTICE TO APPLICANT:If,afar thione this Caofinale d Gacrration,you should WATER SYSTEdAlTRE VDNG
b” Lacrossewbjttt to ted Workers Compcwtim provii iam M Ne.labor Code,you muu SOILS FEE
fuMwilbcompy with worth Provisions or this permit vhall he dCCmdl revoked. WATER SERVICE
0. Q
w ICONSTRUCTION LENDING AGENCY
NEW RESIDENTIAL EhMH. SQFT. PAIDUOIIfd9hi Ihwthine isamnaretidn lending agency for'he per(nmwoDom Rcccip b
" ca work forwhich the pmtit s iwcd(See 3007,Co.C.)
nder's Nonrc TOTAL:Le
{U Linden's Adnan
TOTAL;
I dsnify Ibnt 1 have real the;.ppkuion ed ante Um Its adwc infarttrauon in BUILDING HE
F' h arrest l agree to comply with all city ad county ordimtecs and care laws mlemlg m QTY. MECHANICAL PERMIT FEE
UZ Wilding cdrasmrawm,Wterchy vwhmir<repesentativa ofthis city la enter aper the SEISMIC FEE
andrve-rrcmiared popcny hs in,pec6on purpmes. PERMIT ISSUANCE
(We)a{reeto sus,indemnify ed keep hartud the City of Capered agaiw ELECTRIC tie
IieMlaee.judgments,cost,rural espi which may in any way accrue aguml aid City ALTER OR ADD TO MECH.
in nssquetice of the graming of Nu Permit.
PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONPONTAIR HANDLING UNI'T(r0 111,1X)CEIMJ
SOURCEREC LAITON MECHANICAIJI?I?
AIR HANDLING UND(OVER n,IXX)CFM) CONSTRUCTION TAX
S"h1s TAppliunUCuntowtor Date EXHAUST HOOD(WfDUCT)
HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
olub,appliarm dsfutare Wildieg occvpom store a bade haaanlom ttaerial HEATING UIsTT O0 I00.00D BTUI
va defined by the Culenitn Municipal Code,Cluper 9.13,and the health rud Safety
Cate.Seatidm 85324)1 HLt VINNG UNIT(OVER IIXLq)BTU)
[IYes ❑No PAID
VI!NTTIATON FAN(SINGLE RPSID) Date. Recclpld
KSII the air chsmnl n future wilding byvaPwl y A ea Air Qu a devices which
mit In'rnrdkws air aatvminrunlr as dktined by tW Hey Arca Art Quality Management ftO11AR-COMP(311P 11R IIXI,IMX)BTU)
District? TO'T'AL:
E]Yes C]No BolLITR-COMPIOVBR IIXI,(MXI IfTUI
I have read the hasaNdes m,m,. AIR CONDITIONER
raryirtmcnre udcr Chapter 6.93 Moe Cali- 1,CSUANCE DAT
Wi $
frvtdn I Icahn&Safety Coates Smidslr 25505.85JJ and 255ia.I utvkrvard ddw if the ' L Z
ldingdoesrnrcm
aemdy vcaetwrlL 111rl elan}mponsiNlity m mtify the occupant t`T'W'RESIDFNTIAL MECH. SQ.FT
of pro to usuanc die Certificate a
OwatrlhJlnGl egrnl t TOTAL: ISSUED BY:
i, OFFICE