S 2394 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPE RTINO BUILDING-ELECTRICAL rEumrr No.
BUILDING DIVISION APIIIACATIONA'ERMIT TING PRODBINC�PROJECT
MECHANICAL S 2394
ItUILDINI:I'ROJI:C'T IEF_NTIFICA'IION
1 BUILDING ADDRESS: SANTEARY ND. APPIHCA'UONSUBMI1'IALUAI'li
11r 22'190aglazi-c-
RO . u t INo C15oi4 Q-� 9. 'Poo
RgSSWME.E.` 1 ' HON C)NIIACI(IIt:S AME: �'•/�..� LIC NU, N/CCbMROLW
ARCHIIIEECf/cul: a1N[ R 'K` LIC No AUDKGSS: D�1N /� ❑
CONTACT: PHONE 6UILUING PEkMIT INFO
D4` ��\ ��0� l Q��A�I�} ❑ Consultant Fees Paid by Applicant It1.uG _ [U[CI� 1•I.U❑M1IB ME❑CH
LICENSED CO`NTRACIORV:S DECLARATION V `•/{ Qry ELECTRIC PERMIT 17EE lyFdr'/ 'L—Jr/
I herebv affirm that[.III IicemeJ under pnsvuns of Chapter 9(comnicanag JOB DESCRIPTION
with Sectin aW elha yr v a J of the Busier,,and l•mPmaion,Cud,and my license is PERMIT ISSUANCE RESIDENTIAL,
W '
CSF• ❑SPOWL [2 KITCHEN REMODEL
aZLL Uaensc Class Lic
.Curva sur APPLIANCES-RISIDF.N'I TAI. ❑ADDITION ❑PLUMBING RETIIIll
�aa• ARCHITEC1SDECLARATION ❑MUhTI-UNR ❑STRUCI'l1RAL
Fpm PANES MODIFICATION
N Z I un.hu,anJ my plalls,hull he ecce us puhle overall,
UP' YOU AMPS ❑IN'I'IERIOR ❑CHIMNIiY REPAIR
F-1Fm Llmnud Pude"a ed 301-10XOAMPS IM13ROVEM13N'ISWIMMING POOLS
X22 OWNER-BUILDER DECLARATION OVER IIXX)AMPS O BATH REMODEIJREPAIR ❑DEMOLITION
C st 1 hereby union that I um exempt from the Contractor's Licrnso Law fin the
(Xy O E U following reason,(Sect ion 0031 5,Braine, and Probees,wor,Codecs Any city.. a,,nnty SIGNS I?IJ?LTRICAI. ❑DTIII?k
lu 3 0.y which requira perm,,to vomtract,lther.ximprove.dnnnlish,or repair any structure 2Sf A
0J pro In t.i,amorove.orhas salary,he "Ifo,rad fer,mb permit I,filic.'a,rusil.t dement SPECIAL CIRCUITOXIISC.
third he I,licensed ptt the p-lisinav ofth Contractors I L (Chapter 9
al �0 (.. uti gwith Sol 9(XX))tfD".i l td R , II f..' :Crde)nr TF•MP METER OR MOLE INS'L COMMERCIAL:
y Xe` bar he to exempt therefmn u W rhe half,ter he alleged exempt ar.AnY v'd;n I n of ❑NIiW I{hDG/ADDITION ❑DHMOLI'fION
—H Sealan 7031.5 hyany.Pplicaot far.permilsubjects the applicvnrto a civil Penally'If POWER DEVICE'S E)TENANT [I POOL,NERVICIE
no,, are than five hundred dollar,($5BB. IMPROVE IEN'I'
=Q
01......r,r it the pmpeny.or on,unple,ce,with wage,as their tde compensation, SWIMMING POOL ELECTRIC
1.., will do the werk,Fnd the tracalm is nut I endednndfarcf1
d nr..,(Sri.A94,Bu,iocn, El OTHER
L 3 m and Prafc„ions Cade:The Contracmh Licen,e haw do,,ern apply to an owner of Lot'L1!I'S-SWI'1 CITES-19 X'1'11RES
progeny who build,or fmpmves thereon,and who dues such work himself ar through
his own employee,,pmvidcJ tha such improvement,am not intended of offered for NEW RESIDENTIAL ELECI'R SQ FT.
sulc.11;how cmc hullJingor nrpmunI
cot iv adA within nneyalrofcnmpin....I he SQ.YT FLOOR AREA ASR FC
-buifdcr will have the homes of proving that he did not build or improve for par,runer ,of let '101' L:
of the pmpcny,am e¢Iwivtly commning with liun.ad mrmmaun to
mare,,the to jeer(Sec.7044,Basil ms,md Predmsi rte Inve.)'Ion,COnt1allas 1 Li-
whawdoe,na mppI,"I an Iowa relprapeny wbo hands,,,improvm them oa.tad Q'I'Y. PLUMBING PERMIT NEE
wocenn enrnmetsfr tl prufuea'wi onlracwr(s)licensed Pursuant to the Contractor.
Enuu,"Law. PIERMI E ISSUANCIE
I] lam me t Bk PC for this no
ALIER-DRAIN.&VENT'-WA1ER(1' ,DATION
Ow .un ��((
WORKETS 1•ENSATION DECLARATION BACK FLOW PROTECT.DEVICE 6 O co
1 he d y,,)lute under penally of perjury one o)thesch following Jeelaret Cr
Ihuve and will mnimainn C'crilicate ill Consent tn,clt-in,urc tie W'orkcr,Compcn- DRAINS-R.00R.R(lOF',AREA.GOND' STORIES TYPE C(ONSTRUCI'IfON
anion,os pmvidcJ far by Section 37(X),,l the Lubar Code,tar the pernnmuncc or the
work bar wdeh this permit i,issued.
FI%l'URES-PIiR'I'RAP
0 1 have and will maintain Worker,CuinNn,utian Insurance,an required by Section
3910 of the huMrt Cud,,for the perfrmutnecuf 0e wurk far which Ibis permit is issued. GAS-EA.SYSTHM-I INC 4 OUTLETS (OCC.GROUP APN
My Warkc,'x Cmnpenmtiun lnaurmcc carrier and Policy numlx:r we: GAS-UA.SYS'II1M-OVER4(EA)
Comic, Policy Na:
CERTIFICATEOF17xliMI'llONItROMWORKIERS' GRI:ASFJINDUS'IKI,WASTI:IN'rERCE110R
COMPENSATION INSURANCE BUILDING DIVISION RiIS
(Ihi,nwtinn meminnl b-contpleteJ it thepcmlil inµmune lmnduld dedam(SIM) GREASE TRAP
I'LANCI IECK PEIi
les.)
Ie,any that in any
i,thebecard subject
thermosersC.L.shall SIiWIiR-SANI'T'ARY-S'1 ORAL EA.?TNI Iq'.
nut employ any pews in any mwmenn as m brume subject m the Workers Comlaen- ENERGY FEE
Z. nmlon Lown ill Culitornia.One WATER HEATER WNF,ND ELECTR •RADIN I REE
Z APhlkanl
to
NO]SCE'11)APPLICANT':If aft—making Ihi,Certificate of 13xempbnn,yoF.hand WATER SYS]HfAll REATING SOI
become sabjecl br the Warker'a Compensaian pmvi,ions of Ne Loolan Cute,yuu mrat
CSI r Innbwith comply with such provmom or this permit shall be declined mvaknl. WATER SERVICE
pID
U .Z CIONS'I'RUC'InON LENDING AGENCY NEW BESIDCN'I'I Al,PLMIt. S 'SII pale Reeciptp
U Q Ihereby,,turn that them in a construction lending agency liar the performance of
W. h the wmk In,whlchthin lrv,.I,is issued(Sec.301 Cu,C.) TOTAL:
U Isndar'n Non'u TOTAL
U Lender',Add... Rog", BE
O. I eenily that I have read this application and state that the above inlimnatian is FJ
FN naren.la'.br comply with all city and county eNinamm and tae law'relatingm Q1 Y. MIiCIIANICAL PERI I'P'Y -' SEISMIC IEE ( O
U building ermhretion,and hereby uuthrrimurpresmnutives of this city m enter urym the
ubovomendoned pngmmy fm inspection purpose,. PERMIT ISSUANCE ELIECIXIc PIER
(We)to, too...c,indemnity and keep Inanities,the Clly or Call ban againt
li.biliam.jud 3 Is cost,and cxpenms which may in any way accrue against said City ACI ER OR A DU TO MECH, PLUMBING FETE
inerrant. rte o the grunting oft permit.
APPLICA 'I'U DEKS"D\ND 1 WILL CIOMPLY N' of ALL NON-POINT AIR HANDLING UNIT(TO 111.(00 CFA) MECHANICAL PER
SOI, CE 'LEI t .61' NS.
NR HANDLING UNIT(OVER ID(KK)CIFM) CONS'fRUC'1lON'I'AX
igra I or p ca far Dam EX I IAUST 11001)fed/DUCT') HODS INGMI'1'IGAI'ION FETE
IIA%A R DOUS MAI I7R I ALS UISCLOS U R IE
Withhcapplicanlnr future homing c,,nana 'am lirhandle hamrdons mmcrial HENTT ING UNI'IV'f0100,0N)131 U)
as defined by the Copied.Municipal Code,Chapter 9.12,and the Health and Safely BEATING UNIT(OVER I10,000 B'III)
Ced,Section 25532pa)T
C1 Yes ❑NoPAID
V ENTILATI(IN PAN(SINGLE RESIU) Uwe RecciptN
Will the applicant car future building oe'cupatn use equipment lir devices which BOILER-COMI•CHP OR 100.0OB It'I U)
mil Ramada.,air,can oondrant,as defined by the Bay Arca Air Quality Mawrc
gernt TOT
District? BOILER-COME(OVER 110.000 BTU)
❑Yes El No,
AIR CONDI'I'IONIER ISSUANCE DATE
1 Hart read Inc hvi St irmr255 5,25533 a under .Chapter rsta of the Cali
feted,,Hcallh A Safety ly have
Seniora repair.tha join,and j,ihil I undemand that i!Inc VIEW RFSIUIENTIAL M1:C11. SQ.Fr.
,,Fini se ,c nu[enrrcndyarol or heno,f IM1ait join,. mnur I Clltymnotilylheuccupant
,,Fine myuircn¢nts which most hu Incl prions lv,uunec of a CuniBcate'It UCOlpnncy,
Owner ur authuriaedJ ugrnl
Ilse TOTAL: ISSUED BY:
OFFICE