S 2579APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPF,RTINO nuu.Dm'r. - F:LItC'rxu:,u,
BUILDING DIVISION APPLICATION/PF,RMIT PLUMB N; -MECHANICAL
BUILDING PROJECT IDF.N'1'IF'ICA'I'Ill
BUILDING ADDRESS:
logos MofNN 'DR
Y -
OWNERSNAME: PHONE: CON] RACE OR'S Ii LI
\RCHITIiCT/ GINGER: LIC NO: ADDRESS:
a G u e¢ /0.30 & reef/ Iz S3 G
CONTACT: PHONE:
Z66-77g� ED Consultant Fees Paid by Applicant (Initial)
1 hereby affirm Ihat 1 our licensed under pmvisilmo of Chapter 9 (commencing
0 �'L with Salion➢00).1ilia 3 ft he Btloincvvund P�fcssions Code,I it my liccnw'w
h�Op in full fimmeoadeRect. Le o Lic a 5,5
Date
C 'Lts, ale——�,�t'j�Colnrac ARCHITECTS DECLARATION
F
zooolI z I ound nndemy plamahall be used m mahlie recordx
OZ C
W Licensed Proluxsinnal
OWNI_m exemDIiR D the Car1'ION
C C Q I fill union that 1 am exempt from the Comacmr's License Law fur the
3 , U Inuowing easlo. (Section 9031.5. Business amt P,afcsxions Colt: Any city nr amnry
III which arcane, a permit ,, a amona. almc improve, demolish or repair any sl aclum
G prior u) its issuance also reyuims the applicant Ear such pc.I, to fil... igned statement
that he is licmosed arulun uh the pruvisiom'of lac Cnn.,cmr', License Luw(Chepmr9
�IY�O (commencing with Section ytxa) niTivixion 3 ofmc Business and Professions Codi nt
d k Whin he s exempth
t erefrom and Inc bei, for the alleged cumption. Any violation of
U. U. Secular 703IS by any applicant lot a lwrmhjats it wthe applicant to a civil Ixvully of
t more than five hundred dollars ($510).
FQ I, as owner of l he n
C ❑ past y.mmyet intendedwhhwagdl is Inco- Sec. 044.In.amn.
F- will dothe wons C d e: The outure a tors License offereddoes of apply I) an, weer of
{yarj m and property
mI ns Code The Contractors License law does not apply m an owner of
4i 3 his o ny emp mild, o mpm a [flat such improvements
and who docs salt tinte ded or ffthmugM1
his own employeese pnlding or such mentis sold within
are not intended picood for
cafe.ILhawevegll have th hunimprovement issoldwithinoneycdrofcor(lvc ronn, the
.r-M1uIIJer will have the hunlen of proving taw he Ald not Mhild ar Ilnpmvc fur pun
puvw of ,attest
❑ I, of the pmprny, a sulurively contracting with licensed contractors it,
comlaet the project (Sec. 90,14, Business and I'rafem'ions Cxly:) Tic Contract,,(', I,i-
se Law docs not apply man nwnef,fpropeny who ouildsor improv[, owmoa, lad Q'ry..
wen c,,almic s tar such mIject, with u amhmmrts) licensed p T.... an ,, the Cnnotclors
License law.
I am exempt under Sec. ,B& 1' C for this reason
Owner Date
WOR KEll S COM
ly IIpofamp, aSAl UN t
1 hereby alar undef pcnahr of Perjury one of Inc creme for dcackuptoWorker%Co
oac
❑ I neo and will maintain a Ccri 3700 of Ile Lam self -inure for Workers Compen-
nainn, as providCJ for by San:on 3]011 of the habn: (}ale, fur the Iwrfonn:u¢c of Tec
work for.lub this person is iswd.
E] I hm'c and will mainnoin Worker's Compensation Insurance, as required by Seetinn
39000 he WMor Cotte.I'ot the parlbrnmmce of the ,,,it for which This permit is hewed.
s, (, My Worker's Compensation Insurance Cartier and Policy number am:
Cartiuc Matti Policy No FROM
RKERS (�
CLR1119CA li OF E%1?A1PPolic PROM WORKERS
COMPENSATION INSURANCE
(To, scab. pacul not h completed HIT, crn, iv for ooc Inn lred capon 01(0)
or le,,.)I certify taut in the performance of the work or which this permit N oxaed, l xbull
not employ any persm in any manner so as to hectic stmect l,, Inc Workcc2 Contpen-
0Zon n Law, of California. Dae
Applirtnt
Z N NOTICE TO APPLICANT.. It, after making tui, Catilicam of Exemption, you should
become subject ro the Workers Compensation pmvi,ions of the Labor Calc, you must
foehwull comply with such proviso m. or llis permit shall he deemed revoked.
U0 CONSF atthem is
c JON LENDING AGENCY
U O I hereby allm that I is a um.Sex. 30 lending agency for nae pertihrmance of
Ule nder
furwhichthi, permit is i,.ucJ (Sec. 31199, Civ. C)
Q U Lcnde6 Name
rIl] Lender', AMlrens
0.1 I wrle tum have mud this applicationanand sum Lem the above information olatioo a
U N
correct. l ouxur I,, comply will, all city and county ordinance and scare law, rup in the U z abo-.... wnst...I tiers berthyxuteonfa nrpreumnuvo ofthis city to enter upon tM1c
nbovu(We) agree
to Save rindmpmuonpump 11,
ha
Ise)giumnave, indcmmilyand hich hay in antheyaccoy If quips,
CityIinNl'nic., juJgnrcnt., costs and expenses which may in any way accme agaiml sail City
in mcgoeneu If lac "ninny of this permit.
APPLICWI' UNDERSTANDS AND WILL COMPLY WE rH ALL NON -POINT
SOMEqu%
Signature ,I Appllc:mhCummct,,r Dam
I IAP.ARDOUS MATIiR1AL5 DISCLOSURH
Will the applicant or lab r, building mc'cup int store or handle hazardous mmcrial
as defined by the Copanino Municipal Civil. Chuptcr 9.12. and the Hl and Sully
Code, Section 25532(x)'
�Ycs ky+s�o
win Ine apPlicam mr furore building occupant use nonlinear or devices which
' nit he.arduu. sir amtnmi nano as Jcfinud by the lily Are., Air Quality Ishmae mem
Diwderr
El Yet, 2<o
1 have hand the hvurhaw mamnal, requhements under Chuptcr 6,95 of it Cali -
t I,, Ilan, & S.,fety Gxlc, Sroion, 25545, 25531 and 25534. 1 mNawmd Inn it
builJinnoy�9�vlen:mPt cis my te,Wroibilitym nrnily the occupant
of the uncus a mtFt nn -m+/ m i,mance of a Certificate of Oveni aneY.
Owner or au ifirl agent Date
ELECTRIC PERMIT
PERMIT ISSUANCIi
APPLIANCES - RHSIDF N -HA.
PANELS
UP'D) 21X1 AMPS
281.1010AMPS
OVER IONIAMPS
SIGNS ELF(CfRICA,
TEMP. MISTER OR POLE INS'1'.
POWpR )FVICpS
SWIMMING POOL ELECFRIC
OUIj - SWI DCHCS - FIXTURES
NEW RISIDEN'I JAL Fi.I Cl'R
PLUMBING PERMIT
PERMIT ISSUANCE
A10 Ek - DRAIN & V IiN'I - WATER (EA)
BACK FLOW VROTFCr. DEVICE
BRAINS - FLOUR. BOOB AREA. COND.
FIXTURES - PER TRA'
OAS-IiA. SYS'I'HM-1 INC.40UTL1;TS
GAS -EA. SYSfEM.OVER 4 (EA)
GREASEVUH)USTRL WAS 117 LNTEHCIIPIQR
GRFASE'I'RAI'
12- `t
ins
❑1
ENERGY FEE
GRADING FEE
WATER HEATER WNFE TTLECfR
BUILDING PERMIT INFO
FEE In, ELECT
I'LUMIt MECH
WATER SERVICE
FLI'
JOB DIESCRIPTION
RESIDENTIAL:
❑SPOWL ❑ KI'I CHEN RFMODI;L
El ADDITION ❑PLUMBING RE -PIPE
0MUL1J-UNIT' ❑SIRUCPURAL
MODWICNI ION
❑INTPRIOR ❑ CI II MNEY REPAIR
IMPROVEMENT [ISWIMMING POOLS
❑ BATH RLMOU171 IREPAIR ❑ DEMOLITION
❑ OTHER
NEW RESIDENT IAL PLEB, SQ, FT.
)arc Receipt
a
0"=RIC
TOT .
COMMERCIAL:
❑NEWBLDG/ADDITION
0 ENANT
IMPROVEMENT
❑ o ETIER
❑DEMOLITION
❑ 1'00[) SF;RVICF
EE
QTY. MECHANICAL PERMIT
1'F.E
F.
PERMIT ISSUANCE
lili
SQ, FI'. FLOOR AREA
C—}D
ALTER OR AUDIT) MECIL
$/SU PT.
,UMBING FEE
FEE
STORIES lam urvv rctru nm
� vN
,,.123 2,C Z Y -
cl
BHB.DING DIVISION IPIiS ( _
1'LANCIII!CK I'lili � \ --
SIiWER-SANITARY-STORM EA. 21X114.
ENERGY FEE
GRADING FEE
WATER HEATER WNFE TTLECfR
WATER SYSTEM/rRLA'1'ING
WATER SERVICE
NEW RESIDENT IAL PLEB, SQ, FT.
)arc Receipt
a
0"=RIC
TOT .
I, IAL:
EE
QTY. MECHANICAL PERMIT
1'F.E
F.
PERMIT ISSUANCE
lili
ALTER OR AUDIT) MECIL
,UMBING FEE
AIRHANDLING UNIT ITO 10.00X1 CFM)
trNIANICAL ITE
AIR I IANDLING UNI'I'I OVFR 111,000 CPM)
CONS tUC'I'IONTAX
EXHAUST HOOD (W/DUCT)
HOUSING Nil'I IGATION FEB.
HEATING USE p (TO 110.000 BTU)
HEATING UNIT (OVER INJAX1 BTU)
PAID
VEN'1'II.ATION FAN SINGLE RESIDE
Dvlo Receipt
a
BOILER -COMP (31IP OR 100,000 BTU),
Tf : 5
BOILER -COMP (OVER 110.000 B U)
Alk COND1'I'IONER
ISSUANCE
USEE
NEW RI:MDFNT1A1. MELEE. SQ. 14.
OFFICE
IOl'AL:
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPF,RTINO nuu.Dm'r. - F:LItC'rxu:,u,
BUILDING DIVISION APPLICATION/PF,RMIT PLUMB N; -MECHANICAL
BUILDING PROJECT IDF.N'1'IF'ICA'I'Ill
BUILDING ADDRESS:
logos MofNN 'DR
Y -
OWNERSNAME: PHONE: CON] RACE OR'S Ii LI
\RCHITIiCT/ GINGER: LIC NO: ADDRESS:
a G u e¢ /0.30 & reef/ Iz S3 G
CONTACT: PHONE:
Z66-77g� ED Consultant Fees Paid by Applicant (Initial)
1 hereby affirm Ihat 1 our licensed under pmvisilmo of Chapter 9 (commencing
0 �'L with Salion➢00).1ilia 3 ft he Btloincvvund P�fcssions Code,I it my liccnw'w
h�00 in full fimmeoadeRect. Le o Lic a 5,5
Date
C 'Lts, ale——�,�t'j�Colnrac ARCHITECTS DECLARATION
F
zooolI z I ound nndemy plamahall be used m mahlie recordx
OZ C
W Licensed Proluxsinnal
OWNI_m exemDIiR D the Car1'ION
C C Q I fill union that 1 am exempt from the Comacmr's License Law fur the
3 , U Inuowing easlo. (Section 9031.5. Business amt P,afcsxions Colt: Any city nr amnry
III which arcane, a permit ,, a amona. almc improve, demolish or repair any sl aclum
G prior u) its issuance also reyuims the applicant Ear such pc.I, to fil... igned statement
that he is licmosed arulun uh the pruvisiom'of lac Cnn.,cmr', License Luw(Chepmr9
�IY�O (commencing with Section ytxa) niTivixion 3 ofmc Business and Professions Codi nt
d k Whin he s exempth
t erefrom and Inc bei, for the alleged cumption. Any violation of
U. U. Secular 703IS by any applicant lot a lwrmhjats it wthe applicant to a civil Ixvully of
t more than five hundred dollars ($510).
FQ I, as owner of l he n
C ❑ past y.mmyet intendedwhhwagdl is Inco- Sec. 044.In.amn.
F- will dothe wons C d e: The outure a tors License offereddoes of apply I) an, weer of
{yarj m and property
mI ns Code The Contractors License law does not apply m an owner of
4i 3 his o ny emp mild, o mpm a [flat such improvements
and who docs salt tinte ded or ffthmugM1
his own employeese pnlding or such mentis sold within
are not intended picood for
cafe.ILhawevegll have th hunimprovement issoldwithinoneycdrofcor(lvc ronn, the
.r-M1uIIJer will have the hunlen of proving taw he Ald not Mhild ar Ilnpmvc fur pun
puvw of ,attest
❑ I, of the pmprny, a sulurively contracting with licensed contractors it,
comlaet the project (Sec. 90,14, Business and I'rafem'ions Cxly:) Tic Contract,,(', I,i-
se Law docs not apply man nwnef,fpropeny who ouildsor improv[, owmoa, lad Q'ry..
wen c,,almic s tar such mIject, with u amhmmrts) licensed p T.... an ,, the Cnnotclors
License law.
I am exempt under Sec. ,B& 1' C for this reason
Owner Date
WOR KEll S COM
ly IIpofamp, aSAl UN t
1 hereby alar undef pcnahr of Perjury one of Inc creme for dcackuptoWorker%Co
oac
❑ I neo and will maintain a Ccri 3700 of Ile Lam self -inure for Workers Compen-
nainn, as providCJ for by San:on 3]011 of the habn: (}ale, fur the Iwrfonn:u¢c of Tec
work for.lub this person is iswd.
E] I hm'c and will mainnoin Worker's Compensation Insurance, as required by Seetinn
39000 he WMor Cotte.I'ot the parlbrnmmce of the ,,,it for which This permit is hewed.
s, (, My Worker's Compensation Insurance Cartier and Policy number am:
Cartiuc Matti Policy No FROM
RKERS (�
CLR1119CA li OF E%1?A1PPolic PROM WORKERS
COMPENSATION INSURANCE
(To, scab. pacul not h completed HIT, crn, iv for ooc Inn lred capon 01(0)
or le,,.)I certify taut in the performance of the work or which this permit N oxaed, l xbull
not employ any persm in any manner so as to hectic stmect l,, Inc Workcc2 Contpen-
0Zon n Law, of California. Dae
Applirtnt
Z N NOTICE TO APPLICANT.. It, after making tui, Catilicam of Exemption, you should
become subject ro the Workers Compensation pmvi,ions of the Labor Calc, you must
foehwull comply with such proviso m. or llis permit shall he deemed revoked.
U0 CONSF atthem is
c JON LENDING AGENCY
U O I hereby allm that I is a um.Sex. 30 lending agency for nae pertihrmance of
Ule nder
furwhichthi, permit is i,.ucJ (Sec. 31199, Civ. C)
Q U Lcnde6 Name
rIl] Lender', AMlrens
0.1 I wrle tum have mud this applicationanand sum Lem the above information olatioo a
U N
correct. l ouxur I,, comply will, all city and county ordinance and scare law, rup in the U z abo-.... wnst...I tiers berthyxuteonfa nrpreumnuvo ofthis city to enter upon tM1c
nbovu(We) agree
to Save rindmpmuonpump 11,
ha
Ise)giumnave, indcmmilyand hich hay in antheyaccoy If quips,
CityIinNl'nic., juJgnrcnt., costs and expenses which may in any way accme agaiml sail City
in mcgoeneu If lac "ninny of this permit.
APPLICWI' UNDERSTANDS AND WILL COMPLY WE rH ALL NON -POINT
SOMEqu%
Signature ,I Appllc:mhCummct,,r Dam
I IAP.ARDOUS MATIiR1AL5 DISCLOSURH
Will the applicant or lab r, building mc'cup int store or handle hazardous mmcrial
as defined by the Copanino Municipal Civil. Chuptcr 9.12. and the Hl and Sully
Code, Section 25532(x)'
�Ycs ky+s�o
win Ine apPlicam mr furore building occupant use nonlinear or devices which
' nit he.arduu. sir amtnmi nano as Jcfinud by the lily Are., Air Quality Ishmae mem
Diwderr
El Yet, 2<o
1 have hand the hvurhaw mamnal, requhements under Chuptcr 6,95 of it Cali -
t I,, Ilan, & S.,fety Gxlc, Sroion, 25545, 25531 and 25534. 1 mNawmd Inn it
builJinnoy�9�vlen:mPt cis my te,Wroibilitym nrnily the occupant
of the uncus a mtFt nn -m+/ m i,mance of a Certificate of Oveni aneY.
Owner or au ifirl agent Date
ELECTRIC PERMIT
PERMIT ISSUANCIi
APPLIANCES - RHSIDF N -HA.
PANELS
UP'D) 21X1 AMPS
281.1010AMPS
OVER IONIAMPS
SIGNS ELF(CfRICA,
TEMP. MISTER OR POLE INS'1'.
POWpR )FVICpS
SWIMMING POOL ELECFRIC
OUIj - SWI DCHCS - FIXTURES
NEW RISIDEN'I JAL Fi.I Cl'R
PLUMBING PERMIT
PERMIT ISSUANCE
A10 Ek - DRAIN & V IiN'I - WATER (EA)
BACK FLOW VROTFCr. DEVICE
BRAINS - FLOUR. BOOB AREA. COND.
FIXTURES - PER TRA'
OAS-IiA. SYS'I'HM-1 INC.40UTL1;TS
GAS -EA. SYSfEM.OVER 4 (EA)
GREASEVUH)USTRL WAS 117 LNTEHCIIPIQR
GRFASE'I'RAI'
12- `t
ins
❑1
ENERGY FEE
GRADING FEE
WATER HEATER WNFE TTLECfR
BUILDING PERMIT INFO
FEE In, ELECT
I'LUMIt MECH
WATER SERVICE
FLI'
JOB DIESCRIPTION
RESIDENTIAL:
❑SPOWL ❑ KI'I CHEN RFMODI;L
El ADDITION ❑PLUMBING RE -PIPE
0MUL1J-UNIT' ❑SIRUCPURAL
MODWICNI ION
❑INTPRIOR ❑ CI II MNEY REPAIR
IMPROVEMENT [ISWIMMING POOLS
❑ BATH RLMOU171 IREPAIR ❑ DEMOLITION
❑ OTHER
NEW RESIDENT IAL PLEB, SQ, FT.
)arc Receipt
a
0"=RIC
TOT .
COMMERCIAL:
❑NEWBLDG/ADDITION
0 ENANT
IMPROVEMENT
❑ o ETIER
❑DEMOLITION
❑ 1'00[) SF;RVICF
EE
QTY. MECHANICAL PERMIT
1'F.E
F.
PERMIT ISSUANCE
lili
SQ, FI'. FLOOR AREA
C—}D
ALTER OR AUDIT) MECIL
$/SU PT.
,UMBING FEE
FEE
STORIES lam urvv rctru nm
� vN
,,.123 2,C Z Y -
cl
BHB.DING DIVISION IPIiS ( _
1'LANCIII!CK I'lili � \ --
SIiWER-SANITARY-STORM EA. 21X114.
ENERGY FEE
GRADING FEE
WATER HEATER WNFE TTLECfR
WATER SYSTEM/rRLA'1'ING
WATER SERVICE
NEW RESIDENT IAL PLEB, SQ, FT.
)arc Receipt
a
0"=RIC
TOT .
I, IAL:
EE
QTY. MECHANICAL PERMIT
1'F.E
F.
PERMIT ISSUANCE
lili
ALTER OR AUDIT) MECIL
,UMBING FEE
AIRHANDLING UNIT ITO 10.00X1 CFM)
trNIANICAL ITE
AIR I IANDLING UNI'I'I OVFR 111,000 CPM)
CONS tUC'I'IONTAX
EXHAUST HOOD (W/DUCT)
HOUSING Nil'I IGATION FEB.
HEATING USE p (TO 110.000 BTU)
HEATING UNIT (OVER INJAX1 BTU)
PAID
VEN'1'II.ATION FAN SINGLE RESIDE
Dvlo Receipt
a
BOILER -COMP (31IP OR 100,000 BTU),
Tf : 5
BOILER -COMP (OVER 110.000 B U)
Alk COND1'I'IONER
ISSUANCE
USEE
NEW RI:MDFNT1A1. MELEE. SQ. 14.
OFFICE
IOl'AL: