S 1107 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
BUI L ANC-ELECI RICAL PFRM I T NO.
ICJTY OF CUPEWIFINO I'L=HNG-MECRANICAL
RUILDING DIVISION APPLICATION/PERMIT BUILDING PROJECT IDENTIFICATION S 1107
UILDINGADDRESS�
11201 SAV-01V-01,Teresoisbr, 'Cupefitlilo P�k
NE S NAMH� Aompi,,i LIC NO
ame,,3 —V k-lto" _`T__ SIC CONUDt0I.It
3 R, ,+,6 M-Holl 1q,16 ;Zqba I
CHITEC DIUNGINIVER: LIC NO:
CONTACT PHONE 1:0
0 Consultant Feces Paid by Applicant(initial) fil ECT PLUMB MECH
X—
LICENSED CONTRACTOR'S DECLARATION ELECTRIC PERMIT FEE
QTY JOB DESCRIPTION
w0c, PERMIT ISSUANCE RENIDEN I IAL,
1�1_ in f[If it IT EISFDWL [I KI ICIIHN REMODEL
c : im# APPLIANCI,9-RESIDENTIAL DADDITION 0 PLUMBING III
a"-Chis,
XRCHII HCI S DECLARAI[ON EIMULTI-UNIT [I SI RUC I URAL
PANELS MODIFICATION
Zc)(Az UPTO200AMPS DINEYERIOR CICHIMNEY REPAIR
____14-a
r4jaj Licensed Professional 201-100OAMPS c3s
I�VIROVEMFXII DS IMMINCPOOLS
W OWNER-BIJILDER DECLARATION DEUREPAIR El DEMOLITION
Had I hereby offirm that I am exempt from the CoflorChh'c License Law Ill no — OV17R O00AMPS ATH RIM0
Q.V following reason.(Section 7031.5.Business and Ponfiessions Code:Any city mcumul SIGNS ELECTRICAL 0 ER
hill acquires. .it III constrict, Im�Improve,demolish,or repair anystruchrow
Eatatoisi...anca,dw,refums Iha afthicant hamch pa m ELOIJ,tad imerroul SPECIAL CIRCUI 17MISC.
that hat,licensed purrom loche or..Wons of Ile Conourearr's License 1, Calo," —
aw - I ER OR POLE INST COMMERCIAL
W 1commuccein,with Section 71")of Division I ol Ile Busina,,,and Profession,CoRl III TEMP.ME
bar he is astranto thansforn andube had,f he alleged ammithi.a.Any violation If — D NEW BLDGIADDH[ON 0 DEMOLITION
Section 7031 5 by any applicant hou POTtabsonaCs tho4ppliCam to 11 civil reirriqui POWER DEVICES
a,, an,ramadim live hundred debtor,gild). — L1 TENANT El 1700D S17RVICE
0 1,res awaser ofthe propsnY,or my employees with wages as their sole compensation, SWIMMING POOL IB_CC IRIC IMPROVEMEN I
will do the work,and the shmation is not intended at offered for sale(Sec.70,14,Business — SWITCHE S-FIXTURE S 00THER
and Professions Code 'no Cormistor's License Low discs our apply to an owner of OUTLETS e94
properry who builds or improves thereon,and sho does such work,himisaffor through
his ..employee,,provided that such improvement,..a.,intended molmocil far NEW RESIDENTIAL 17LECTR SQFF.
sale.If,howeve, he buildingorimprovervent issold within one yearrolfcont'pletion.the SISQ 17,
owneclaudder will have tire burden of forroving flum he did riot build or improve fur put-
save cdf,ala.). JOIAL,
C]1,as owner of dic prilverty.am exclusively contracting with licensed contorcurvan city
construct the project(See 704,L Business and Professions C(xw:j I he-..........I i- FEE
cence Law doci not apply or an owner of property who builds or improves Itherron,and QTY. PLUMBWJ PE Ift,
> AT
0 0
who contracts for such projects w di a contractoos)licensed pursuant to the Conlracior's FEE E
Lican"Law PERMIT ISSUANCE.
rl I..amour under Sec.—,B A,P C fordir.Or.....
Ovor" Date ALTER-BRAIN&VENT!j1,!erEjLEAUk_.,� VALUXI[ON
W0RKI_-'-'RSCOM ENSAIICINDECLARATION BACK FLOW PROTECT DEVICIE-c-- \
I hereby affins,under Penalty of parjury one of the following declarations 095%
1 have unit will maintain a Certificate of Consent to self-insum for Worker's Comper- DRAINS-FLOOR,ROGF.AREA,C C: S I GRIPS TYPE CONSTRUCTIO1
Ificiral jum,clad I by Section 3700 of the Labor Cole,for,he performance oI the - U
,v k for which fais parma is issued MIXTURES-PER
[D I have ad Oil maintain Winker's Compensation a,reptifiriol by Section —
37M of the CalmoCade.((it the parrinniance offibe work for which this twout is issued. GAS-EA.SYSTEM I INC.4 OUTL p- OCC.GROUP APN
My Wokct,C..N.,nnuart insturalle O.1ormad Policy hilawriow
Carrier: Policy NO,: CIAS-FA.SYSI EM OVER 4(HA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANC GREASEJINDUSTRL WASTE INI RECEPTOR BUILDING DIVISION FEES
(This section recut not th,a ii,leced i I the perml is far one ImadoOddollars IS 100) CREASE r I RAP
or an") — PLANCi RICK PER
Imnif,that in the perfamormac.filia is, k Imsibich his Ewout is issued,Witill SEWER-SANITARY-STORM HA.200 IT
hot confelity any�Dan in say manner so as to becons,so thaw Ion,Conthen- ENERGY FEE
Imicar 1��umca Data tcll_ WATER HFATER W/VENTfULFC-1 R
!..El 1 =11
'A,,Iic.n I ' — q- ;4 GRADINC.FEE
z NOTICE'TITAPPLICAN7,If.after cracking this Cerfiricam of Exempffon,youshould WATER SYSTEWOULU ING SOBS THE
hinearric,adol,amdre Wtakin',Compereadior,araskicarof the Labo,Code. cm hum,
bodo,ifit v p],will such .......his Iscand,slohl he damosedmenkad. WATER SERVICE
C's 0 CONSTRUC TION LENDING AGENCY NEW RESIDEIGIAL PLMB. Sis�rL. PAID
:::) z Date at,
U 0 1 hereby affirm that them is a construction lending agency for the ovirformance of
'he work ror which this Permit is issued(See,IML Cie,C.)
4' Landa,,Name IOTAL:
0 Laradar',Addra,s IDIAL:
I caddy that I have head this aMlication and state that ths,above information is BUILDING 4,
ps I
Uj correct.I agree to cotattly with all city and county ordinances and shate laws calming to CITY, MECHANICAL PERMIT SEISMIC FEE
U 7 Imildio,on,oroctic.,and hendryaudsovens,....courw.I,f this city I,,enter tOran the .`7 f)
admIc-comifitared Isropi f amlimum a,p,).,. PERM]T ISSUANCE ELECTRIC FEE
(we)agree m,moc.indemnify and keep h.)a,,the City 4C.Operflo)almost 1 4
liabilities,judgments,costs and cilsenses which may inany way accore against said City' AUTER OR ADDTO MECIL PLUM13ING FEE
in cormcloon.iffth. matioluflifl,proarl, —
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING USE f(TO 10,000 CI`M) MECHANICAL THE
SOURCE REGULATIONS.
CONS I RUCTION TAX
AIR HANDLING UNIT(OVER 10,000CFM)
o',,,ph'a [)are HXHA US T HOOD W/DUCT) 7E
HOUSING MITICAd[ON
HA7ARDOUS MATERIALS DISCLOSURE
Will the applicant or far..ladidurig..pan,umco,handle Ithermtrima..,.He] HEATING UNIT UD 100,000 B WE
as defifired by the Copen am Moucci fad Circle,Chapter 9.12,and the I Icahn and Safety
Codc,Section 25532(.)? H EA!I NO UNIT(OVER 100,000 It FLO
ye,, )JN. V�� ILATION FAN SINGLE.RESID) PAID Date Reecith 0
HE the applicant or future building occupant use caluipment or devices which
Wous air contaminants its defined by the Bay Area Air Quality Marogrolam BOILER-COMP(3HP OR 100,000 BTU) TOIAIL:
lauh,"W BOILER-COMPGVER 100.000ITTU)
0Ycs Ileb"
firmiht�tra,emill Iluchareardica,noteri.1sheraimonat,maIc,Ch.Ehrr6.95 OrfleCal, — AIR CONDITIONER ISSUANCE DATE
calth&Safely CWI Section,25505,45533 and 255.� I understand that if(lie NEW RESIDEN FIA I�MECH, SO,FT.
Im Ing (nonsuch atly have a mmah.that it is my ownumduilay to ratify the occupant —
of the raquiremenWwouch A�� ,:;W02Ccdflficaueof cu I .
I Aq, /_ - ' -7
Ovvionmrrrhh��Mrcisarh Dffla- JUIAL: ISSUED BY:
OFFICE
HOLL RES.
MASTER BATH PLAt,I
t p
JAN 121998
GFI
NEW SUPPLYLNIM BLDG. INSPECTION DEPARTMENT
CULTURED MARBLE TOP
TIE N TO ERIYTNG
TRAP ARWI
(N CARNET)
WALK-IN CLOSET
(N)EXHAUSTFAN
v
NEW VAN MY
DRAWER
STACK \
.... ........
NEW SNKS
• CULTURED M4RBLE
SHWR& PAN
GFI
l 42"X42" PA
N `
WfC
TILE FLOOR
CENTER
(N)EXHAUSTFAN J,iDRAIN&
(TIMER SW ITCH) SHOWER
FAUCET
•