No preview available
S 2350 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUI'ER'1'INO BUILDING-RLECII'RICAL VERMIT NO, BUILDING DIVISION APPLICATIONM'ERMIT rLunutlrvr..hm:cunwc,M. O 2350 OJCJ O -.l I4UILIIINCPROAP:L'TIfIEN'fIPICACION ,. '/ + l7 BUILDING ADDRESS/: � :;ARY NO. AI`PLICAI'ION SUItMI'I'fAI.DATIi Z Z(i JT2f� n$ ur/l �O�%3��G OW iR'S NAMIi: ��+ PIIONIi. CONTRACTOR'S NAME:' LIC NO'. 171_1r� 11S S CONrT�HOLX AItC AI'/ENGINEI:If. E,IC NO: ADDRESS: Z © l Co SGS coNlac'1': PHONE: OUILDING NERMI'C INFO .' 4 �sHltant Fees Paid by Applicant(Initial BLDG ELECT PLUMB MECII 4&1 LICENSED CONTH GCON'S DECLARATION v ',FIiE�' `QTY. LLECTRIC PERMIT a I', 1 hereby off..a that 1 mm fi,,f,ed under prcvisinnl..r cl+apwr umnmenr;.Ig JOB DESCRIPTION M=z w uh ScOin 190fHBuf Division 3ofmc Bminessand Prafesa,n'_Code.Tied my liecnw is RFSIDENTIAl, WOFT, PERMIT ISSUANCE Fly in full force an I elfem. ❑SI'DWI. ❑KI I CHI7N REMODEL aUV License Class hic'M APPLIANCES-RESIDEN'rlAh ❑ADDITION ❑PLUMBING RE-PIPE hZ41 Dery Commcmr rnQy ❑MUL'1'1-UNIT ❑STRUCTURAL, ARC(IIT F.CCS UECLARA'I ION p.?m PANELS CHIMNEY Af10N OZ-n IunJcmmnd ley Plane Aulll M+uxnl Tia public axonlx UI"r021111AMPS p2,..0 ❑INTEItI01t ❑CHIMNIiY REI'AIk F„L.,W Licersal Perfcssimal 201-1000AMPS IMPROVEMENT 0SWIMMING POOLS OWNER-lit JILDFR DECLARATION OVER 1000AMPS ❑BATH REMODEIJREPAIR ❑DI?MOLITION W C W:; 1 thereby ofirrn that I am exempt from d r Comrucmh I.aT law far We x O1 U following reason.(Sean....90315,Bmmros and 11e,!,ions Cale:Any Opp or county SIGNS ELECTRICAL ❑OI'HEK W-1ka'- whirl.reapdratio prTmit to mnnvum,al(I improve,nemorsh.or repair any structure Fpp.y.OG prima,if,'., 1 y ' th PPI: d mr,tichpe lofile.,itinal,lacran SPECIAL CiRCUI'l/MISC. ppppq{C N Chat ba,hicare,alturronamaI,mucturrofilar,in RILIC.'ame"an,I alroleilow(Ch'pa') W AG (L nlcnenb with Scclnm 90011 dObnd 3ofdc Blseca dl ndeaxionx Cale)or '('CMP.METER OR POLtiINs'll COMMERCIAL: Gym y Ill.,he is ceempt therefrom and the had,for the Nlc6cd asentaimI.Any violation of NEW 13 )G/ADDITION ❑DEM01.1TION W-.te Section 70315 ll p by any applicant fnrmwit snhjcdxlhum..pliant n+auivil panathyof POWER DEVICES )I+ ❑FOODSERVICE FZQas nate than rive huMred Jo11ae,($500) ROV EMEN'I' ❑I,as owner of the properly,or my employee,with wages as tbeirwlecompensaunn, SWIMMING POOL IT YCIIUC will do the work,and the structure h not immlaedorolfred forsul,(Scu.9049,Buxinexs �Of ” ca W 3 and Prdes,itow Coca 'Me Contractor',License law dons not apply to an owner of OUTLE'I:S-SWI'I'CI IES-FIXTURES property who builds or improve,Iheman.and who does ouch work himsell or ihr'Ingh his own employer,IT led mm such ingmavemems arc ern immured or okered Ino NEW RESIDENTIAL LLECTR SQ FI'. sale.IL however,the buildiegar improvenlem i,Bald within SQ.FT.FLOOR AREA $/SQ.Fn er-budder will have me burden of proving Lha ncdld ern huilA or impnrve f r pur- Im,y, I:I L r TOTAL: a'aw net of the property exclusivelycontracting with licensed 1 1 - I ,(l�yj\ L the project(S ]BYl Florets Laid Ponessions Coder I F ­1111allaol err,'Lao,doe,no, mlytaruLP n ly 9 thailfor ine,atdreamon,and QTY.. FLi1MBING PERMIT FEE''-1 U� whocontracts for suchprojects with a commemrtp licensed.. at h)the Contractors - Licoma Inw. PERMITISSUANCE ❑ lame B&P C for this reason tri;l'i7R-DRAIN&VL'N'I'-WAl'ER(EA) VALIIAI'ION Gait Dale WORKER'S COMPIiNSATION DECLARATION BACK FLOW PRO]I=DEVICE 1 hereby affiml under penally of pacjury Tine of me bellow ing dccland arts: ❑I haveandwill miumbuna Cenilicvtenf Cnn...Itu elf-imam or ,Warkcr'u Comic. DRAINS-F1,OOR.ROOF AREA,GOND' STORIES 'fYPE CONS,RUCTION ,liou,,.......liked for by Suction 3710 of the Lean.Care,baTho perfnmmnce of the work far which this permit is i... I FIX'I'FIRES-PER TRAP I leave and will maintain Worker's Con,er,o ion Insmmac,as rerplireJ by Section 39004lbe Labor Codq Radar fro,ponmance aflhe work for whiah,hi,parim is issued. GAS-I;A.SYS'I'EM-1 INC.40I1'fLITS OCC GROUP APN My Workers CoNpemalion Insurance career and Policy number arc: - C...ice Policy No, OAS—FA.SYs rem OVER 4(EA) C17RTIFICAI'IT OI'EXEM(TION FROM WORKERS' GRIiASIi/INDUSTHI.WASTE IN'I'EHC H COhIP1iNSA]ION INSURANCE - E1J11.DING DIVISION FEES 1'fhis leelion need nal beamlplemd it lhepemtil is 4a nnehnndeadalk..C510B) GREASE THAI' ur less) LANCI IF.CK IrEE Is r I cenifythat in ,,m"anaance of ihewnrkiinwhichlhi,the ut W.k...Cor,hall SEW'GR-SANI'CAR RM C.-W ITT I nal employ any person In m"an unhe Wnrlore'Cnmpcm F. IiRGY P" S f O ,Z Law.laws of California.Data WATER HEATER W/VI: i .CI .f` OO Applicant I ` GH DING IrG 4 NOGCE TO APPIACAN'C IL ahoy making 111.1 Ccrullcaa of Elluldlen.Ynu should WATER SYSTIiMO REAT I-^ ^ become.hire,to the Worker's Cnmpcnsainn provisions of the IsMm Calc,you nm4 SOILS I1.F. iaLl forthwith comply an such pmvi.cions or Ibis permit shill be dennedrevoked. WA'I'Eli SERVICE � zCONSTRUCTION LENDING AGENCY NIiW RESIDENLIAI.I'LMII. Pe\ID I herehyvffinm Callhcre is ror,aro Ciinn lending agency lin the Fellinlnancc of um R"ri" [DLO the wet k for which this pit is isanall(Sec.IC99,Or,CJ )Tel Q Lender',Name Lenders AJJw TUTAL: - BIJI i FEE flyd'Ilb 'de, . Ipl t Ltl men aM ' form' is LFi h c "t 16 1 ply )h all city 1 ry ordinances III I rcl I gin QTY, MECHANICALIPERMIT - f. FEF; U Z buld'16 :t I Laidh by d I . ri 'unh i" loop be SEISM 1/-FEE2-0 nh I'nred prop ly far in,peetion purpoea. PI'HMIT ISSUANCE (Wel agree to sale,indemnify and keep harmless the City o1 Cupcnien against I:l.l C C FEL? Iiahililies,judgmemv,Lothian].,enans which may in any way lmcceagaina Laid City ALTLR OR ADD TO MEC(I. PhUMIiiN 'FEL! in xnrycnce of the gramin,of this permit. APPLICANT OWILL COAT I'hY WITH ALL NON-POINT AIR HANDLING UNI'I'(TO I0,00ICPM} MIiCIIANICAI.FEL: ' SOURCE I 1LA770 _ _ 5 AI R I IANDLING UNIT(OVER 10.000 CFM) CONS7RUCTR)N TAX 5 ma Iwren "7. Cnnlmaor Date EX HAUS)'I IOOD(W/DUCE) HOUSING MITIGATION FEE HAZARDOUS MATHRIALS DISCLOSURE Wiliam opplicvni or fuwm building mcupum store nr handle hitmadou,mutia al HEATING UNIT C10❑A19E00 B'1'UI us dellard by the Capone,M nicipal Cale,Canine,9.12,and the licalm ImJ S'afe,y Code.Section 2553200! 1,l l'INC ONI'P(OVER 100,000 It'I'U) El Yes VENTILATION FAN(SINGLE RF.SID) PAID gall Receipt It rWill the applicant or future building occupant use c lmlancedor devires nhlch -COMP(3HP OR 100,000 PTU) emil hazardous air conelminana'defined by the Bay Arca Air QuaEty Manegcmcnl BOILERrO DistricB /1 ❑Yen lie, IfOILI?R-COMPIDVER Il10,OfN1I1TU) Ihw ove read the hull duanlnurial,rcgniren+ealx under Chi er 6.95 ofthe Cali- AIR CON DII'IONEN ISSUANCE DAT F. facia Health&Safety Calc,Sections 25585,25533 and 25534.1 mdemaml(hal if the NEW RESIDENTIAL MGCIL SQ.IT. 1milJlhaveutenanl.Ihat ilkmy resl'an,ibilily mnlnify mu avnpu°I ( Il ( J r � le rrnwrcmrnt. et nrimmiaxnanrn and eertirmte of Oren - y. I TOTAL: ISSUED BY. OFFICE