S 3001APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPI1,RTINO BUILDING - FLEc rRICAL
ItI111.DINI. Dn'ISION APPLICA•1'ION/PERMIT rl.u5nnvc-an?ciinNlcnl
NAME�� PRONE:
" : "U sf ✓� S l V FJ
LICENSEOCONTRACIO 'S DECLATCUION QTY.
I hereby OR! ... d n:' I I I i i themed and, ...%)vino. Id Cla,der v lemnmmndny
HOZ with Seclion]INN))ol Division 3oOhe Buslnmand Profcsdn,Cdre.a�n�d ntylicenw,
ZLLD in full,Class d ellen. - 67i� 7p 1
V hittn.w Class CO.,
L-ZM Date Contrennr is
ARCHITECT'S DECLARATION
rOn Z 1 understand Illy plans shall be used es puh1w records
OZ -0
F 14 t 1 Licensed Professional
� •� OWNER-RUILDER I ECLAItA'I'TON
C C Q 1 hereby of rte that 1 am exempt from the Contractor's Liceine law far the
XL U following rcuson. (Suction 7031.5. Business and Professions Calc: Any city or county
n13 LL y which requires v permit to construct, alter, improve, den mIII I. or .rpmr any s.....a e
0
� prior ht it issuance also requires the applicant for. such penman file aligned statement
jthan Ile i s licensed pursuanun the provisions of the Contractor's license Loc (Chapter 9
X 00 fcatmtcncing vinh Scction 700ficl Division 3olthell:ninwst Pml'cssiunsCodld or
a 6 C that he is Island therefrom and the basis for the alleged exemption. Any vitiation of
'K �_tr• Scnlnn]U31.5by:my applicmlfornpermit euM1jcnxthe applicantmacavil penalty of
W w of nun a than live hundred dollars ($500)
Q ❑ I, as owner of the p.,a, ,, my employees wish wages as their sole atmpim-lo n.
p., will do the work, and the structure is not intended or offered for sale (Sec. 71,14, Husin�/'a
W:,: 3 m and Professions Code: 'Ilse Commetidx License Law Joe, not apply to an nwne/u
propeny who build, or improves theman, and who dors such wod, himself or III all
his entlloyee,, provided that Inch improvements arc ani intended or offered for
sale �IC however, the handing or Improvemetn is xtid wdhin ono Yen' ofa'mPletiun, the
owner -builder will have the burden of proving that he did not build or improve for put -
01 sale.).
r of the property, sat exclusively contracting with licensed contractors to
n
nsweuhe project (Sec. 70,11fal. Business and Professi tin CNet) The Committal's Li -
, ,e Law des ant apply tit nn owner of pmperly who builds ur intprtse, ificreon, and QTY.
who con ncls for such pmjeets with a a,nwnor(s) licensed ImmmanUo the Contractors
License Law.
❑ ansxtnpt underSec. 11 1'C(rthis reason
Owner esu 1t
IVA
[� Si" h" T/f l 4/�{ Tsd,
_ uli"ant Fces Paid by Applic7n[ (India )
ELECTRIC PERMIT FEE
I• ,RMI'f ISSUANCE /--I
APPLIANCES - RESHAiN'I'IAL
PANELS
UI"TO 200AM1,S '
SIGNS
POWER
OU'Il.1:T'S-SWI 'i CIIR Lis /
NEW RESIDENTIAL ELECT R SQ FI.
PLUMBING PERMIT
FERMI r ISSUANCE _
ALL 1:R - DRAIN & VENT I'- WA'ITR IRA)
BACK FLOW VROIEC`L DEV ICI!
I hereby affirm order pi Of .enols ane Ill the follrwing dcdamoons'.
J l have and will maintain a Certificate of Consent towel( -Insure for Workers Compere DRAINS- FLOOR, ROOF. A REA. COND.
satins, as pnovided far by Scnion 3700 of Inc Latin Code, far the perfin-ma. of be
Ran k for which this permit is issued. FIX PORES - PER IRAI'
'1 have and will rnuimmin Workers Compensation Insurance, as acquired by Section
P(Nlof the Laboc,
r Gdl'nt the Ferforanno, wet the work for which this peoailr11 111.eeddd. GAS -IiA. SYS TEM- I INC. 4 OUTLETS
My Worcs y pa et¢ryRGa I/1 rPocy Nay��'qa"c1- ""` " GAS -IiA. SYSTEM -OVER 4IRA)
cinder: 1 Y`a 1 Yom'
CI!li'I'l1 ICA'II!OFIi%lib If FROM WORKERS' GREAMYINDUS'I'Rt, WAST I! IN I'ERCEFIUIf
COMPENSATION INSURANCE
(Thisxcciun need not becomplcaed ifdhep mtiti,foronchundmddollars(410U) GREASETRAP
Loy any thmint in dommaccutinymrmersdtheworkhn%obje Itis permit isirs' rd. I hallCramer. SEWER -SANT fARY-STORhf EA. 200 FT.
_
not employ any person in any manner ul as In become ,object In the Workers' Compere
Z salon Lawson Califnmih. laic WAFER IIEAITR W/VIiNT IEl.1!CTR
0 C Applicata
_h
NO[ 'ICF 'rU APPLICANT: If. after [ranking this Ccniticae of Exemption. You,hould WATER SYS'r[SIOREArING
f"s become subja't to the Warkcrs Gm,pcmatum provixinm of the hvMa Cada you omen
{ora � fonhwith comply with suet previsions or )his permit ,hallMJttmeJ revoked. WATER SERVICE
asQ CONS' I'RUCI'ION LENDING AGENCY NEW RESIDES 'I'IAL PLMB. SQ. IN'.
U 0 1 hereby affirm their them is a anmtrucaion lending agency for the performance of
F' the work for which this wrnat is ),sued (Sec YN7. Cre. CJ
Ulender's Nana
19 Lenders AEdacss
04 1 ctidy that I have read Ibis applicant and ,lane that he above inflo ndian is
r N c un'm. l agree ro comply all all city and roomy nnllnma e, and ore laws relating to QT'Y.
U Z building construction. and hereby mnhome mpresenmtire, Of Ibis city to corer upon the
ulwve-mm..tlomed lropcny lin inspection pur,wel.
(We) agree to save, indemnify and keep harmless the City ul' Cuprnino against
liabilities. judgments, cows and expi which may in any way acerae again,) aid Cil/
in ctvncgnenee of the grunting o1'thls permtit.
A VI'LICANT UNDERS'I'ANUS ANtj WIJ�1. COM FLY WITH ALL. NON -POINT
I IAZAIt DOUS MA'I'17RIALS JUSCLOSURE
Will the applicant or future building overload .Imre nr handle h.milars mmerial
as defined by the C,wri no Municipal Cad, Chapter 4.12, and the Ileahh and Safety
Code, Seen.... 25532(m)]
E] Yes yQ n
Will the applicant or (mum building rccol all vee eyripmund rr device, which
hae.Nous air camaminums as defined by the Hay Area Air Quality Manageme.I
wadrr!
U Yes X
1 have read the huaardons nmmriaE requirements under Chapter 6.95 of the Cali-
Irmin Ilealth & Safety Calc, Scoria, 25505. 2553.1 ;,,to 25534. 1 undedhn l Lha II the
building drcsddyy��eeeeppecmly have a haam. that It �nspomihility to roify the occupant
of the renui memalwnirn mry,�e nn,rrtJ/?,ni y R[yVnitieme rr(htnnnr>/ .
MECHANICAL PFRMI'F
PERMIT' ISSUANCE `J a
ALTER ORADDTOMECIL % e
AIR HANDLING UNIT OO 111,0011 CIFNR
AIR HANDLING UNIT (OVER IO.000 CFM)
E%IIAUST HOOD OVIDUCT)
HEAL LNG UNIT fl O IDIIJAId li'i'U)
HEATING UNIT (OVER UILL(Lost Rru)
VENTILATION FAN (SINGLE REMD)
BOILER -COMP OI1P OR 1 ')(I art It IIJ)
BOILER -COMP (OVER 10R.000 H'IU)
AIR CONOI'11ION17R
NBW RESIDI!NTIAt, MSCI I. SQ 1T.
FEE
e.
S.. 3001
SANITARY Nld. APPLICA PION SUBMITTAL DAL'
to /20A
N/C CONI ROLM
� ❑
BUILDING�I� 1INFO
��
BLIV ELEC' III UM Ifs MIiCH
JOB DESCRIPTION ION
RESIDENTIAL'
❑SFDWL ❑ KITCHEN REMODEL
'$�ADOI'I'ION ❑ PLUMBING REPAY
El MULL I -UNIT ❑STRUC'FURAL
MODIFICATION
aylAll'E{HOft-�' CHI 1' REPAIR
MPROVEf�I_I'a',VJ�T\\ rrII SW N0i'G POOLS
AT 11 R{,MODISIlItIiPAIN� Dlih )LION
Ri HI:R
TV'
M FR
NIiW BLDG/AUDITION ❑ DEMOLII' ON
SAS ICE
IM H
❑ O'1'l1ER
SQ.11.1100 AREA $SQ.I-n
q, go
Cin/l3 1. V L/� / ay�j /�/ ,,, t �9
! /
3a.75
6 6 I:/i
BUILDING DIVISION I'1!ES
PLANCIIECK FILE
ENERGY FEE
GRADING FEE
SOILS ITE
PAID
Dunn Rc_0 a
CIL TO1 AL:
SEISMIC
CON5rRlJC�)K L\% I
f{Of1SING MITIGATION FEE
PAID
Dam Receipts
ISSUED BY:
-/— / I V/
ISSUANCE DAI'IiR
IVA
[� Si" h" T/f l 4/�{ Tsd,
_ uli"ant Fces Paid by Applic7n[ (India )
ELECTRIC PERMIT FEE
I• ,RMI'f ISSUANCE /--I
APPLIANCES - RESHAiN'I'IAL
PANELS
UI"TO 200AM1,S '
SIGNS
POWER
OU'Il.1:T'S-SWI 'i CIIR Lis /
NEW RESIDENTIAL ELECT R SQ FI.
PLUMBING PERMIT
FERMI r ISSUANCE _
ALL 1:R - DRAIN & VENT I'- WA'ITR IRA)
BACK FLOW VROIEC`L DEV ICI!
I hereby affirm order pi Of .enols ane Ill the follrwing dcdamoons'.
J l have and will maintain a Certificate of Consent towel( -Insure for Workers Compere DRAINS- FLOOR, ROOF. A REA. COND.
satins, as pnovided far by Scnion 3700 of Inc Latin Code, far the perfin-ma. of be
Ran k for which this permit is issued. FIX PORES - PER IRAI'
'1 have and will rnuimmin Workers Compensation Insurance, as acquired by Section
P(Nlof the Laboc,
r Gdl'nt the Ferforanno, wet the work for which this peoailr11 111.eeddd. GAS -IiA. SYS TEM- I INC. 4 OUTLETS
My Worcs y pa et¢ryRGa I/1 rPocy Nay��'qa"c1- ""` " GAS -IiA. SYSTEM -OVER 4IRA)
cinder: 1 Y`a 1 Yom'
CI!li'I'l1 ICA'II!OFIi%lib If FROM WORKERS' GREAMYINDUS'I'Rt, WAST I! IN I'ERCEFIUIf
COMPENSATION INSURANCE
(Thisxcciun need not becomplcaed ifdhep mtiti,foronchundmddollars(410U) GREASETRAP
Loy any thmint in dommaccutinymrmersdtheworkhn%obje Itis permit isirs' rd. I hallCramer. SEWER -SANT fARY-STORhf EA. 200 FT.
_
not employ any person in any manner ul as In become ,object In the Workers' Compere
Z salon Lawson Califnmih. laic WAFER IIEAITR W/VIiNT IEl.1!CTR
0 C Applicata
_h
NO[ 'ICF 'rU APPLICANT: If. after [ranking this Ccniticae of Exemption. You,hould WATER SYS'r[SIOREArING
f"s become subja't to the Warkcrs Gm,pcmatum provixinm of the hvMa Cada you omen
{ora � fonhwith comply with suet previsions or )his permit ,hallMJttmeJ revoked. WATER SERVICE
asQ CONS' I'RUCI'ION LENDING AGENCY NEW RESIDES 'I'IAL PLMB. SQ. IN'.
U 0 1 hereby affirm their them is a anmtrucaion lending agency for the performance of
F' the work for which this wrnat is ),sued (Sec YN7. Cre. CJ
Ulender's Nana
19 Lenders AEdacss
04 1 ctidy that I have read Ibis applicant and ,lane that he above inflo ndian is
r N c un'm. l agree ro comply all all city and roomy nnllnma e, and ore laws relating to QT'Y.
U Z building construction. and hereby mnhome mpresenmtire, Of Ibis city to corer upon the
ulwve-mm..tlomed lropcny lin inspection pur,wel.
(We) agree to save, indemnify and keep harmless the City ul' Cuprnino against
liabilities. judgments, cows and expi which may in any way acerae again,) aid Cil/
in ctvncgnenee of the grunting o1'thls permtit.
A VI'LICANT UNDERS'I'ANUS ANtj WIJ�1. COM FLY WITH ALL. NON -POINT
I IAZAIt DOUS MA'I'17RIALS JUSCLOSURE
Will the applicant or future building overload .Imre nr handle h.milars mmerial
as defined by the C,wri no Municipal Cad, Chapter 4.12, and the Ileahh and Safety
Code, Seen.... 25532(m)]
E] Yes yQ n
Will the applicant or (mum building rccol all vee eyripmund rr device, which
hae.Nous air camaminums as defined by the Hay Area Air Quality Manageme.I
wadrr!
U Yes X
1 have read the huaardons nmmriaE requirements under Chapter 6.95 of the Cali-
Irmin Ilealth & Safety Calc, Scoria, 25505. 2553.1 ;,,to 25534. 1 undedhn l Lha II the
building drcsddyy��eeeeppecmly have a haam. that It �nspomihility to roify the occupant
of the renui memalwnirn mry,�e nn,rrtJ/?,ni y R[yVnitieme rr(htnnnr>/ .
MECHANICAL PFRMI'F
PERMIT' ISSUANCE `J a
ALTER ORADDTOMECIL % e
AIR HANDLING UNIT OO 111,0011 CIFNR
AIR HANDLING UNIT (OVER IO.000 CFM)
E%IIAUST HOOD OVIDUCT)
HEAL LNG UNIT fl O IDIIJAId li'i'U)
HEATING UNIT (OVER UILL(Lost Rru)
VENTILATION FAN (SINGLE REMD)
BOILER -COMP OI1P OR 1 ')(I art It IIJ)
BOILER -COMP (OVER 10R.000 H'IU)
AIR CONOI'11ION17R
NBW RESIDI!NTIAt, MSCI I. SQ 1T.
FEE
e.
S.. 3001
SANITARY Nld. APPLICA PION SUBMITTAL DAL'
to /20A
N/C CONI ROLM
� ❑
BUILDING�I� 1INFO
��
BLIV ELEC' III UM Ifs MIiCH
JOB DESCRIPTION ION
RESIDENTIAL'
❑SFDWL ❑ KITCHEN REMODEL
'$�ADOI'I'ION ❑ PLUMBING REPAY
El MULL I -UNIT ❑STRUC'FURAL
MODIFICATION
aylAll'E{HOft-�' CHI 1' REPAIR
MPROVEf�I_I'a',VJ�T\\ rrII SW N0i'G POOLS
AT 11 R{,MODISIlItIiPAIN� Dlih )LION
Ri HI:R
TV'
M FR
NIiW BLDG/AUDITION ❑ DEMOLII' ON
SAS ICE
IM H
❑ O'1'l1ER
SQ.11.1100 AREA $SQ.I-n
q, go
Cin/l3 1. V L/� / ay�j /�/ ,,, t �9
! /
3a.75
6 6 I:/i
BUILDING DIVISION I'1!ES
PLANCIIECK FILE
ENERGY FEE
GRADING FEE
SOILS ITE
PAID
Dunn Rc_0 a
CIL TO1 AL:
SEISMIC
CON5rRlJC�)K L\% I
f{Of1SING MITIGATION FEE
PAID
Dam Receipts
ISSUED BY:
-/— / I V/
ISSUANCE DAI'IiR