S 0673 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY -
CITYOFCOPERTINO BUILDING.-ELECTRICAL PERMIT NO. �^
BUILDING DIVISION APPLICATION/PERMIT PLUMBING,-MECHANICAL � O v
` +IIUII.DINGPROJI?CTIDFY'PII+ICAI'ION r' v
BUILDING ADDRESS: - Fi
APPLICATIONSUHMI'I1 DATE
_ All
OWNS ' N li:
PI IIINH: CONTR OR'S NAME LIC NO'
CON'fRD1.N
ARCH T CpIENGINEEHIC 1-IC ADDRESS ft, 8�7
CONTnCf., ` PnorlH. - r ' BUILDIN (PERMIT NIC)
may,. I �/�� _ � ❑ Consultant Fees Paid by Applicant(Initial) n'yG ELUC' PLUMB MECCH
J✓/JI!/�7 LICENSED CONTRAC I ORS DECIARAI ION
QTY f/ ECIiCTI21C PERMIT'( , t r "+ FEfi>
IM1ereny ammnhn a.licensed made,turvilion,of Chapter 9(commencing I it e JOB D85CRIPTION
ZZ
with Section l(XE(p of D' isinn3nf the Pus Bess and vn fie:: its Cole aNnry l'ce mm tc NESIUFNTIAL
WOO PFRMITISSUANCF.
W
ill Fall forceandeffect. ❑SFDWL ❑KITCI I EN REMODEL
aUV Licence Clea LichAPPLIANCE-RE$IDENTIAI. ❑ADDI'T'ION ❑I'hUMBIN(1 RE PIPIT
u,<i nem Comn¢mr ❑muLTI-UNIT ❑STRUCTURAL
ARCHITECTS DECLARATION PANELS MODIFICATION
ZO � IondcrnonJ my plans shall bon red nx Public Ii OZ
r UPTO 2011 AMPS ❑INTERIOR [I CHIMNEY REPAIR
following ereby ti ina that
7031.5.lliscisila II and Corale,n OVER MOAM Ih1PROVEMENT ❑SWIMMIYG POOLS
�'y�y t W hkenscd Pnd'esxional
oG a 1 hereby uffrni oeV�aoaimuin fEllromECLARAT;ONr'n Liccnsa Low for the OVER IU(MIAMPS ❑BATH I2EMODEIJRHI'AIR �IffiM(il.l'I'ION
y W� P ❑O'T'HER
O Vwlc:Any city nr anmtY SIGNS ELECT'RICAI.
3 W,j which paimpes a permit to construct,alter,improve,demolish,or repair any structure
ON; prior( is vsname,al requires theapplicant hpermtt II signed Vmfmreat SPECIAL CIRCOIT/MIST. '
on ,hath - 1pors I( the p Isco of C m I t (Chapter•)
Iec COMMERCIAL; -
ea.Q. tet g with Sea ](X)nl a nano I o r R .- nim f. ' is mien or 'ItMi'.METfER OR i'OLL'(NST.
a d ey Sec hen exempt therefrom and the therm lits the alleged exempiiou.Any viper nn r f ❑NEW BIAG/ADDITION '0 DEMOLITION
N $cminn]f131.5 by any applicant fruit permit sukjcros the xpplicam ro n civil penalty of POWER DEVICES 1 ANT ❑FOOD SERVICE
= not mare than five hundred did...($500). - IMPROVEM i
�=Q 01,as ownendthe prnpeny.nnny cmpinyces with xmges as their sole cnmpensnfion, SWIMMING POOL ELECI'RIG t
will do the warp and tbcstrucmm is not intended or offered for sale(Sec.7044,Business ❑OTHER
Iagj m and 11..II ions Code:The Convector's latense Law does not apply 10 an owner of OUTLETS-SWITCHES-FIX'NRFS
property who builds or improves thereon,and who does such work hinivEl'or though
fits own employees,povidetl thou such inFoocntenks no nm intended nr offered for NEW RESIDENTIAL ELI7CM SQ FC
,dI.If,fmatc cuthe building or improvement isaold wiffiin nneyearofecarr (ion,the i, R SQ FI.
acne b IJ will h thelocal t pn g that I 1'd an build pr in,,p
pn L 1 ) TOTAL ���
❑1 n f thep p nY ly contracting 'd J t t
construct Il pmi GIS 70)44 Business dlrf :Cvd )ThC tract L fir -
cenxLv d ( pplyf a fp pe lY h n 'IJ 'nit .th J QTysr rl 'PLUMB( II e I FEE•'
whcommon,forsuchpojectswthtcom ctm(s)IcensedpursuamurtheCom marc r CITY Ur WYtHIINU
License law. PERM1'1'ISSUANCE
❑ I oa,mxmnpl under see. ,It&P C for this reason
ALTER-DRAIN&VENT- TL'R f' VALUnI'ION
Owner - Dole
WORKERS COMPENSATION DECLARAI ION BACK FLAW'I'ROI'I!C'i'.DEVICE _ 66C r1
1 Land woffaitallerphnW,,ofperjurynaeofthefollowingdmrker's is V
❑ Ihave and will maintain Cenifcmeof he Labor
wde.for for Workers Comp en- DRAINS-FLWR,RO(11'.AI OND. OPAID
IES 'IYI'E C(NSIRUCHON
wtirn,m' hick hi Tamm Section 3]rtuof theLhhnr CnJc,for the peNnmmnan(( aIA
D 1larrwhich ill nuimma rowed PI%'fU12PS-I'ER'1'RAI'
❑Ihave and willinhimain Workers Cnmpen.ewion In,wmnre,nn mquimJ M1y Sce(ion39TH(nlthe LaMn@ule,(onhe performvnee ofthe work for which this pemait is iacueJ. CAS-EA.SYSTEM-I INC.40 f E'I'S OUP APN
My Walkefa��tpc sat'm Iryyymos a corder mad Policy n mCarriee OO 7 Policy No.: GAS-EA.SYST11 OVIiR 4(E)OCERTIFICATE OF EXEMPTION FROM ORKEItS' GRHASIVINDUSTRL WASTE IM'ERCHITCOMPENSATION INSURANCE. UILDING DIVL' N111(Ibis section need not dcompleted Lire Permit is for one hundred dulla,s($100) 41
GRI?ASE TRAYEI certify that in the performance ofrhe work Scrunch this Permit is issued,)shall SEWER-SANITARY-S FORM PA.21X1 FI'.notemploy any person in tiny manner so hs hi Ixzoma subjectto tire Workers'Compin-Znation Laws ofCalifomia.Dam WAYERHEA'IERWIVENT/ELECITt QZ Applicant t
NOTICE TO APPLICANT:If,after making this Ceni9cnm of Ewmplum.you shuld WATER SYSTIzM(I BEATINGbecome subject to the Worker's Compensation provisions of the Lubar Code,)oo mux(forthwith cnntplYwi(h such Provisions or this permit shall be demoted revoked. WATER SERVICE
CONSTRUCTION LENDING AGENCV NF.W RFSIDIJJTIAI.I'Lh111. SQ.EI'.VQgRwup(N
U (be worktor which this permit is iswed(Sec.'lark],Co.C.)
� 'Leaders,.N - - TO
L J AJd : ITYI'AI.
ff�"' 0. 1 certify Raniln art tb': PPI J:(t fhot(h bo f f s .< -- ., ,e, BUILDING PER
1-7
F.ih areef I agreuou Bittywill,all say nautili (Y ..fina-c,and'rate loos' Fine"' .QTY. .. MECHANICAL PERMIT.- '14 FE -
V Z building construction.and hereby intuitable represomtives of this city taenterupon the r.i SEISMIC,fEIi
.base properly for lnspellon purposes. PIRMI'I'ISSUANCE ELECTRICFEE
(We)agree to save,indemnify and keep hannlecs the City of Criterion against
liuhiliaies,judgmema,costsand expenses which inuy in any way vccme."jr,t,iud Cjy' ACfERORADDTOMF.CH. PLUMBING FEE
in walrence of he grunting of this permit. -
APPLICA . DSy1ND WILL COMPLY.WITH ALL NON-POINT Alli HANDLING UNII'(To I0,(0007M) MI?GHANICAI.FHH
S REGO
AIR HANDI-ENG ONE I'(OVER 10,005 CFM) - CONST RUCl'ION'PAX
in um, p ant/Confinemr Dam EXHAUSTHOOD(WIDUCT) HOUSING MITIGADON FET:
HAZARDOUS MATERIALS DISCLOSURE: r
Will the applicamorman,tuildingoOrquout afore orlmndlchuruNous romenal HEATING UNIT TO (10,000111'11) ,
as defined by the Captain,Municipal Code,Chapmr 9,12,and the Health and Safe,, HIIATING UNIT(DVIil1 Ilxi fxxl fiTU)
Cole,Section 25532(a)I IVED _
❑Yes 0 N _ VENTILATION PAN(SINGLE RESIDE PAID Dale Itccci a It
Will the applicant or future building occupant use equipment or devices which ]NEWRESIDEiIIALMECTI.
BOILER-COMI'(1111'OR IW,INIII I{TU)
mi(hainrdnus air comomi...is as defined by the Bay Area Air Qmdi,,,M....moenf
701n
Dlsmm'I - BOILER-COMP(OVER In(L,E)R IJ) ,
❑Yc. ON. .
I baso read the haranlous n ate ak usmiretnemx unit,Chapter h 95 of the CaliA11
IR CONDITIONER �Sam.Awad&Sarmy Cade.Sections 25505.25533 and 25534.1 unden mrsi fhm if the SQ.IT.
holding does ao(conen(Iy have a aca,un dan is is my respm,.bEq as notify(hc oecapem
(if the,mlrVenenR which mus(he met prior it,ionaace of a Csomeone of Occupancy.
Owner or awhomed agent Date 'I'Ol'AL: ISSUEDBY;'
OFFICE