26947 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CIk..
RTINO ,DTM" PERMITNO.
APPLICATIONIPERMIT PLUMBING-MECHANICAL
26947
` 9 7
BUILDING DIVISION �,.�{ /�///�/� IIUII,DING PROJIr,CT'1111iN'I'IFICA'fION v v 1
BUI �w/— /� r SANITARY NO. API'LICATONSUBMITPALDATH
�Nl'fN LOT
OWPI B: CONTRACTOR'S NAME: LIC NO:
N/C CONTROL#
RR: LIC NO: ADDRESS: ❑
CONTACT: PHONE: QTY..11' ELECTRIC;PERMIT FEE BUILDING PERMIT INFO
BLDG ELECT UMB MECH
PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION
APPLIANCES-RESIDENTIAL
MetZ Iherebyeffrnthutlamlicemadunderprovisionsoochter9(comm gwith
LOB E
�OO Satio90)afUivision3afNe sinsndrofesonsCo ,mmyticuisin
PANEIS
K full fmc<and eJ(at.. /s ,# �(� UP TO 200 AMPS
Ice.Z License Class.5.;i](1 L c.# s3.0SO'sa
snag Data Contractor 201-I"AMPS
Z�yZ ARCHITECT'S DECLARATION OVER 100JAMPS SQ.FT.FLOOR AREA $/SQ.FT.
CZ-0 1 understand my plans shell ba used as public memd.
F.yy W SIGNS ELECHUCAL
�a "J Licensed Professional w �� t�
a OWNER-BUILDER DECLARATION SPECIAL CIRCUTT/M a�l
apM9pd,C) lu 1 hereby affirm that 1 am exempt from the Contractor's License Law for the _
W:Oy¢ following uason.(Section 7031.5,Business and professions Code:Any city or county TEMP.METER POLE INST.
'�
rn J which requires a Permit to construct,altar,improve,demolish,in repair any swenue
pdorto its issuance.also raryires the applicant foreuch permit to file a signed comment POWER D ICES
mull Q Om that he is licensed pursuant te,the pmvisions of the Cmummu rs License Lnw(Chapter
2ax oLL 9(commencing with Section 7")nf Division 3 alto,Business and Rafessarm Code) SWI INO POOL ELECTRIC ALUATION
Wim mthet he is exempt thercfmm and Ne bazisfor the alleged axcmption.Any viohtion of
FZQ Stttiun T03l.5bysnyapplicantforapermitsubjatstheapplicantmacivil,e tyof OEES-SWITCHES-
--
not mom than rive hundred dollars($500). NEW RLSIDHNTIAL ELECTR S .FT.
Wm ❑ I,asow°ernfthe property,nrmyemployeeewith wagesas theirsolemmpcnsetion, Q STORIES TYPECONSTRUCI'ION
a will do the work,and theawcWrc is not ioendedoroffetdforsale(See Jt144,Business /
and Professions Code:The Contradols Licanse law does not imply to an owner of
pmmeny whothaddsorimprovesthercan,and whidoesmchwork himselforthrough his OCC.GROUP RFS.UNITS
con employees,providedthatsuch improvememren
saremotindedoroffered farsale.If,
however,the building or improvement is sold within oneyear of completion,the owner- TOTAL:
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
CILasowner ofthe property,amexclusivelyrontracting with licensedconwetors or QTY. PLUMBING PERMIT FEE FLOOD ZONE ApN
construct the project(Sec.70,14,Business"professions Code:)The Conn..,'. PERMIT ISSUANCE
License Lawdoes not applytosmownerofprameny,whobuildsorimpmvesturean,and
who controls fcureb projects winittemractems)Iicensedpunuanttothe Conowness
License low. ALTER-DRAIN&VPN -WATGR(EA)) FEE SUMMARY
❑ 1 am exempt under Sea. ,B&P C for this mason BACK FLOW PROTECT.DEVICE D S
SANITARY YN
Owner Date DRAINS-FLOOR,ROOIr,AREACONO RECEIPT#
WORKMAN COMPENSATION DECLARATION , SCHOOLTAX YN_
❑ )hereby affirm Natlhaveacenificamofcansent w self-irsme,ora ttrtificacof RECEIPT#
Warkcn'Cam FIXTURES-PER TRAP
penatian lnsumnce oracenified copy thareof(Stt.3803,1ab C.7 which PARK FEE VN
covars all crosu i s c t. GAS-HA.SYSTEM.I INC.4 OUTLETS RECEIPT#
Fdicy# ze BUILDING DIVISION FEES
p
Company a GAS-EA,SYSTEM-OVER 4(FA) PLANCHECK HE
❑ grn fled ropy is hereby furnished.
P"teri ted copy is fled with the city inspection division. GREASPANDUSTRI.WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF HXEMPTION FROM WORKERS' 0REASI.TRAP SOILS FEE
COMPENSATION INSURANCH
(This section need not becnmpleted if he permitu for one hundred dallao($100) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE
or lass)
I certify that in the piabormanceof the wok for which this permit is issued,l shall WATER HEATER W/VENT/ELECTR
am employ any person in any runner so as to become subject to the Workers' PAID
Compemsrtionlawrof California. Data WATER SYSTEM/TREATING Dem Receipt#
O Z Applicant
Z O NOTICE TO APPLICANT:ILafter makingthfs Cartfficateof Exemption,ymidnuld NEW RESIDENTIAL PLM. SQ.FT. TOTAL:
rf/] becomeeubjecmothe Wmkais Compensation provisiansofthe Latin,Code,you must
� ; forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING FEE
1 [] CONSTRUCTION LENDING AGENCY SEISMIC FEE
Z I hereby affirm that there is a construction lending agency for the performance of AL: ELECRtIC FEE
V O the wok for which this permit is issued(Sec.3699,Civ.CJ
w fir Lender's Name PLUMBING PEE /#
U Land I certify
the QTY. MECHANICAL PERMIT Ter,
Uj I certify thn I have read this application and sum that the above information is
acored.lagree ta comply wit all city and county ardirlsnttsend sum laws relating to PERMIT ISSUANCE MECHANICAL FEE
to building construction,and hereby audience representatives ofthis city toenterupon the CONSTRUCTION TAX
L) Z above-mentioned poperry for inspection u,,,a,. ALTERORADDTOMECH.
(We)agree to save.indemnify and kap harmless the City of Cupenum against
Iiubiliues,judgmems,cosu andertonses which may manywayaccrue against said City AIR HANDLING UNIT(TO 10.000
gwr—
in consequence of the granting of this permit.
AIR HANDLING UNIT(OV I0,l103CPM)
Signore of AppliestroCommuctor Data EXHAUST HOOD UCD
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING U (TO 103,000 BTU) Data Raceipt#
rore
Will the applicant or fubuilding occupant store or handle hazardous material
as deltoid bythe Cumtroom Munict�m/m�Code,Chapter 9.12,and the Health and Safety HEATI uNIT(OVER 103,0301TU)
Code.Section 25532(°)? / V TILATIONPAIN(SINGLG RESID)
EI Y. QR
OILER-COMP(311P OR 103,030 BTU)
ISSUANCE.DATE
Will theapplicantorfutumbuildingmeupunmwequipmentordevicaswbichemit g�
huaurdous air con ti iuum,us def ncp.by the Bay Area Air Quality Management BOILER-COW(OVER 100,000 BTU) y� p
Di...mI l.YraJ/ + D
❑Yea NEW RESIDENTIAL MECH. SQ.IT.
I have read the haZNdaas materials requirements under Chapter 6.95 of the Nov 2 Q -
Calikmmla Health&Safety Code,Sections 25505,25533 end 25534. 1 understand that V
Hilt building dee mcu nI It .1ensnt,thv itismyosponsibilityonotifythe
occupaol of the mire t h act prior to issuance a(a Certificate of �rY Uh l,l(i�f/r�J�Qjw/�y//�,
Owner or muthoriuJ°gent cur c � D:ne TOTAL: ISSUED BY:
OFFICE
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CIk..
RTINO ,DTM" PERMITNO.
APPLICATIONIPERMIT PLUMBING-MECHANICAL
26947
` 9 7
BUILDING DIVISION �,.�{ /�///�/� IIUII,DING PROJIr,CT'1111iN'I'IFICA'fION v v 1
BUI �w/— /� r SANITARY NO. API'LICATONSUBMITPALDATH
�Nl'fN LOT
OWPI B: CONTRACTOR'S NAME: LIC NO:
N/C CONTROL#
RR: LIC NO: ADDRESS: ❑
CONTACT: PHONE: QTY..11' ELECTRIC;PERMIT FEE BUILDING PERMIT INFO
BLDG ELECT UMB MECH
PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION
APPLIANCES-RESIDENTIAL
MetZ Iherebyeffrnthutlamlicemadunderprovisionsoochter9(comm gwith
LOB E
�OO Satio90)afUivision3afNe sinsndrofesonsCo ,mmyticuisin
PANEIS
K full fmc<and eJ(at.. /s ,# �(� UP TO 200 AMPS
Ice.Z License Class.5.;i](1 L c.# s3.0SO'sa
snag Data Contractor 201-I"AMPS
Z�yZ ARCHITECT'S DECLARATION OVER 100JAMPS SQ.FT.FLOOR AREA $/SQ.FT.
CZ-0 1 understand my plans shell ba used as public memd.
F.yy W SIGNS ELECHUCAL
�a "J Licensed Professional w �� t�
a OWNER-BUILDER DECLARATION SPECIAL CIRCUTT/M a�l
apM9pd,C) lu 1 hereby affirm that 1 am exempt from the Contractor's License Law for the _
W:Oy¢ following uason.(Section 7031.5,Business and professions Code:Any city or county TEMP.METER POLE INST.
'�
rn J which requires a Permit to construct,altar,improve,demolish,in repair any swenue
pdorto its issuance.also raryires the applicant foreuch permit to file a signed comment POWER D ICES
mull Q Om that he is licensed pursuant te,the pmvisions of the Cmummu rs License Lnw(Chapter
2ax oLL 9(commencing with Section 7")nf Division 3 alto,Business and Rafessarm Code) SWI INO POOL ELECTRIC ALUATION
Wim mthet he is exempt thercfmm and Ne bazisfor the alleged axcmption.Any viohtion of
FZQ Stttiun T03l.5bysnyapplicantforapermitsubjatstheapplicantmacivil,e tyof OEES-SWITCHES-
--
not mom than rive hundred dollars($500). NEW RLSIDHNTIAL ELECTR S .FT.
Wm ❑ I,asow°ernfthe property,nrmyemployeeewith wagesas theirsolemmpcnsetion, Q STORIES TYPECONSTRUCI'ION
a will do the work,and theawcWrc is not ioendedoroffetdforsale(See Jt144,Business /
and Professions Code:The Contradols Licanse law does not imply to an owner of
pmmeny whothaddsorimprovesthercan,and whidoesmchwork himselforthrough his OCC.GROUP RFS.UNITS
con employees,providedthatsuch improvememren
saremotindedoroffered farsale.If,
however,the building or improvement is sold within oneyear of completion,the owner- TOTAL:
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
CILasowner ofthe property,amexclusivelyrontracting with licensedconwetors or QTY. PLUMBING PERMIT FEE FLOOD ZONE ApN
construct the project(Sec.70,14,Business"professions Code:)The Conn..,'. PERMIT ISSUANCE
License Lawdoes not applytosmownerofprameny,whobuildsorimpmvesturean,and
who controls fcureb projects winittemractems)Iicensedpunuanttothe Conowness
License low. ALTER-DRAIN&VPN -WATGR(EA)) FEE SUMMARY
❑ 1 am exempt under Sea. ,B&P C for this mason BACK FLOW PROTECT.DEVICE D S
SANITARY YN
Owner Date DRAINS-FLOOR,ROOIr,AREACONO RECEIPT#
WORKMAN COMPENSATION DECLARATION , SCHOOLTAX YN_
❑ )hereby affirm Natlhaveacenificamofcansent w self-irsme,ora ttrtificacof RECEIPT#
Warkcn'Cam FIXTURES-PER TRAP
penatian lnsumnce oracenified copy thareof(Stt.3803,1ab C.7 which PARK FEE VN
covars all crosu i s c t. GAS-HA.SYSTEM.I INC.4 OUTLETS RECEIPT#
Fdicy# ze BUILDING DIVISION FEES
p
Company a GAS-EA,SYSTEM-OVER 4(FA) PLANCHECK HE
❑ grn fled ropy is hereby furnished.
P"teri ted copy is fled with the city inspection division. GREASPANDUSTRI.WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF HXEMPTION FROM WORKERS' 0REASI.TRAP SOILS FEE
COMPENSATION INSURANCH
(This section need not becnmpleted if he permitu for one hundred dallao($100) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE
or lass)
I certify that in the piabormanceof the wok for which this permit is issued,l shall WATER HEATER W/VENT/ELECTR
am employ any person in any runner so as to become subject to the Workers' PAID
Compemsrtionlawrof California. Data WATER SYSTEM/TREATING Dem Receipt#
O Z Applicant
Z O NOTICE TO APPLICANT:ILafter makingthfs Cartfficateof Exemption,ymidnuld NEW RESIDENTIAL PLM. SQ.FT. TOTAL:
rf/] becomeeubjecmothe Wmkais Compensation provisiansofthe Latin,Code,you must
� ; forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING FEE
1 [] CONSTRUCTION LENDING AGENCY SEISMIC FEE
Z I hereby affirm that there is a construction lending agency for the performance of AL: ELECRtIC FEE
V O the wok for which this permit is issued(Sec.3699,Civ.CJ
w fir Lender's Name PLUMBING PEE /#
U Land I certify
the QTY. MECHANICAL PERMIT Ter,
Uj I certify thn I have read this application and sum that the above information is
acored.lagree ta comply wit all city and county ardirlsnttsend sum laws relating to PERMIT ISSUANCE MECHANICAL FEE
to building construction,and hereby audience representatives ofthis city toenterupon the CONSTRUCTION TAX
L) Z above-mentioned poperry for inspection u,,,a,. ALTERORADDTOMECH.
(We)agree to save.indemnify and kap harmless the City of Cupenum against
Iiubiliues,judgmems,cosu andertonses which may manywayaccrue against said City AIR HANDLING UNIT(TO 10.000
gwr—
in consequence of the granting of this permit.
AIR HANDLING UNIT(OV I0,l103CPM)
Signore of AppliestroCommuctor Data EXHAUST HOOD UCD
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING U (TO 103,000 BTU) Data Raceipt#
rore
Will the applicant or fubuilding occupant store or handle hazardous material
as deltoid bythe Cumtroom Munict�m/m�Code,Chapter 9.12,and the Health and Safety HEATI uNIT(OVER 103,0301TU)
Code.Section 25532(°)? / V TILATIONPAIN(SINGLG RESID)
EI Y. QR
OILER-COMP(311P OR 103,030 BTU)
ISSUANCE.DATE
Will theapplicantorfutumbuildingmeupunmwequipmentordevicaswbichemit g�
huaurdous air con ti iuum,us def ncp.by the Bay Area Air Quality Management BOILER-COW(OVER 100,000 BTU) y� p
Di...mI l.YraJ/ + D
❑Yea NEW RESIDENTIAL MECH. SQ.IT.
I have read the haZNdaas materials requirements under Chapter 6.95 of the Nov 2 Q -
Calikmmla Health&Safety Code,Sections 25505,25533 end 25534. 1 understand that V
Hilt building dee mcu nI It .1ensnt,thv itismyosponsibilityonotifythe
occupaol of the mire t h act prior to issuance a(a Certificate of �rY Uh l,l(i�f/r�J�Qjw/�y//�,
Owner or muthoriuJ°gent cur c � D:ne TOTAL: ISSUED BY:
OFFICE