20385 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification PIiRMITNO.
Building Address: - 20385
044 st H ctba
cora came: Ilhone: p
%*-(k U ; \ ' goo^AgS6o�� CITYOFCUPE TINO- I N IVISION ����
ctnnQIJame: Ile,No; APPLE T IT
laic S I S
BUILDING UMB - KCHANICAL CATEGORY CONTROL Y
Architect/Enidecer. Lie.No:
QTY ELE iC FEE BUILDING PERMIT INFO. w - � SLUG EdDZI FLUME MELEE
-
Address PERMITI CE ❑ ® ❑ ❑
Lmthat)iA CONTRACTOR'S DECLARATION of Chapter
h ON
Ihereby
ectim,mthan aiv Bm%3o under prwWonsafesedoer9(mmmenc APPLE RESIDE L ]OB D65CRIP170N '
IngwlthSM1on7000)ol Dlvislon3tfthe Buaineseand ProleulonsCode,and my
license is in tullyfr�;�n deffet. P
License Claes Lie#
Date Contractor r
ARCHITECPS DECLARATION 201-1 75
Z I understand my plane shall be used az s OVER1 public recordSQ.FT.FLOOR AREA f/SQ.Ff.
CO
(/ Licensed professional SIGNS ELECTRI
OWNER-BUILDER DECLARATION
12!1, IherebyalRrmtM1atlam exempt from the Contractor's License law for the SPECIALCIRCUI /MLSC Vs
following reason.(Section 7031.5,Buelnen and Pro(embne Code:Any city or
Eltp�"tu� county which requires a permit to construct,alter,improve,demolish,or repair TEMP.METER OAPOLE INSf.
O 5.? any structure prior to its Issuance,also requires the appBanl for such permit to POWER DEVICES
Bk a sIgAM statement that he Is licensed pursuant to the provide.of the
Contractor'sLicense law(Chapter 9(commendng with Section 7000)of Divi- SWIMMING]VIOL ELECTRIC
Sion 3 ofile Business And PmesnloaaCode)tribal he is exempt therefromand VALUATION
the hash for the alleged exemption. Any violation of Section 7031.5 by any OUTLETSSWITCHFSFTXTURES
autt
ppBant fora perMlsub)is the applicant to a civil perultyof nu momthan \
five hundred dollars(5500).
�n ❑7,as owner of the NEW RESIDENTIAL ELEC7RSQ.Ff. STORIES TYPE CONSTRUCTION'
property,or he employees Is with wages r thele sok _
compenaatlon,B.,n o the work,and theatr odurch not Intended or offered for
O sale(Sec Apply BoAnowca,owner
fpropAPnrf.ty Code: or impnots 1hre m Law
$ does ran Apply loanownerofprough his who nempoyees,pvndedthatand
S^ whodoementsas such onetIrk ntended hrofferedowale.lE o,everviibuild[such `_� OCC.CROUP NIS.UNITS
improvements tintendAeyear (comorsak.the o nveq tilderwdI have TOTAL: I_Jl•{�_'1s^MU
Improverrcnt lssold wlthlnoneyearafcompidlon,theowner-bulidcrwill have
1119kurden of proving that he did nor build or Improve for purpose ofsakJ. QTy. PLUMBING PERMIT FEE F-LOODZDNE APN
Lj L as owner of the property,am exclusively contracting with licensed pp RISSUANCE
contractors to construct the project(Sec.70K Business and Professions Code:
The Contractor's License Taw does not apply to an owner of property who ALTER-DRAIN&VENT-WATER(EA)
Wilda or improves thereon, and who contracts for such pojeccts with aFEE SUMMARY
cgplpdor(s)Ilcenaed pursuant to the Contndory License Law. BACK FLOW PROTECT.DEVICE
LI I am exempt under Sec. e&P C for thin reasonOUTSI QF FEES
Owner ate
DRAINS AREA,FLOOK ROOF,ARCOND. SANITARY Y N_
DRE)CEBET M
y WORKMAN COMPENSATION DECLARATION FIXTURES-PER TRAP SCHOOL TAX Y N
Idifi hereby affirm that I have a I. ate of commnl d epythemof or a RECD,s
3800 abC Worken'Compereatlonlnsurance oracertllicd copythereo((Sec. GAS EA.SYSTEM-]INCA OUTLEfS PARK PEE Y N
Policy I �5� 'j S —CREC
NG 'f R
GAS F.A.EA.SYSfG1-0VFR 4(Eom A) BUILDING DIVISION FEES
UCertlfled copy's hereby furnished. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCI-IECK PEE
Certified copy I.filed with the city Inspection division.
CERTIFICATE OF E(EMPTION FROM WOR KERS' GREASE TRAP PAID
INSURANCE
NSURANCB SEWER-SANITARY-STORM EA 200FT Date ReceI t#
Rhtsxctlan need not be completedpermit bfor one hundred dollars
(ft00)orlese.) WATER HEATER W/VENT/ELECTR ENERGYFEE Y N
lartif at n Ko n sof hewtrk forwhlc tM1ls read!blwaed,
I shall not ploy,a person n n) manner m as Ad to the WATER SYSTEhI/TREATING
Wmlare'C at on Lawso 10 la.Dace PAID
O Z Appllca NEW,RESIDENTIAL PLMB. SQn. Date Recei t#
Z O NOTICE OAP ICANT:IL afters Ing/his CertBlatc of Exemption,you
ahwld .N.0 Iect to the Wt 'Compensation provialons of the Labor TOTAL:
~ N Code,younastlorthwithcompl thsuchprovlsiotsorthlspermtahallbe
W > deemed revoked. BUILDING FEE
a c CONSTRUCTION LENDING AGENCY SEISMIC FEE
Z 1herem byaffirthat there is a comtraction lendingagency,for the perform TOTAL: ELECTRIC FEE s
ance of the work for which this permit Islat ed(See 309],Civ.C.)
u O Lnnder'e Name - PLUMBING FEE
IL 1= LemiceaAddress QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
OW (certify that baveread this application and Catethattheabovein(ormatlon
IL lscorred.]agreelocomplywithaildtyandcountyordlnanosandpatelawe PERMIT ISSUANCE FEES PAID:
W relating to building construction,and hereby authorize representatives ofthis
Z city to enter upon the abovcmentioned properly for Inspection purposes. ALTERORADDTOMECH. Date RCCCI t#
— (Wo)agree to save,Indemnify an d keep harndess the City of Cu portion
against liabilities,judgments,coats and expenses which may In any way amus AIR HANDLING UNIT OO 10,000 CFM) SUBTOTAL:
ARA Inst said City in camaxt enre of the grant Ing of this permit. -
AIR HANDLING UNIT(OVER 10,00oCFM) CONSTRUCTION TAX
Signature of Applicant/Contractor Data EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will thea ppllcant or future building occupant store or he Ad le hazardous HEATING UNIT(TO 100,000 BTU) Date ReCci t#
material as defined by the CuprAlno Municipal Code,Chapter 9.12,and the —P
Health and Safety Cod a Section 25532(a)? HEATING UNIT(OVER 100,000 BTU TOTAL:
F1 yes No
Will the applicant or ture building occupant use equipment or devices VENA LATION FAN(SINGLE BESIDE ISSUANCE DATE
which emit harerdous air contaminants as defined by the Bay Area Air
Quality Management District? BOILER-COMP(317P OR 100,000 BTU ['AID
Yee ❑n No
have re ad the h.9..a terlals requirements underChapter 6.95 of BOILER COMP(OVER 100,000 BN)
theCalifornia Health&Safetyode,Sections 25505,25533 and 25530. I 7 1990
nderstandI tlhebu In docs not mrrcntly have atenan4 that ltlsmy NEW RESIDENIAL MECH. SQ.FT. MAY 1 ry
ponsibilityton ity a pantoltherequircreard which athe met
PV
issuancoof ateof Occupancy.
s / 4 City of r.11�n nn
nenuhorimc!a rat DateI
TOTAL: ISSUED-
OFFICE
SSUEDBOFFICE COPY