S 1280 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CI'EY:QE CUPER'I'INO BUILDINC-ELECTRICAL Poi IT NO 1 //�
ISUILDING DIVISION APPLICATION/PERMIT 1'LUMBI NG-MRCI[AN ICA1. y L H O
BUILDING PRoJEC1'IDBN'19FICNUON
BUB.DINC.ADDRF_SS: SANITARY NO. APPLICATION SUBMI'I'1'ALoDA'I'E.
r �- Q./f
ER SM PHONE qCONTRACTOR'S NAME. LIC NONIC
n-7 4E LL Co
: V
I 31 C(1N I'ROI,p
kwiliq
'1111ECI'/ENGINEER: FIC No: ADDRESS:' NXI5101a ❑
CONTACT: I'uONg; BUILIJING PIiRM IT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECII
❑ ❑ W'1 ❑
I.ICI!NSI;DCONTRACII)R'SDECI.ARAI'ION QTY. ELECTRIC PERMIT FEC JOB DESCRIPTION
1 hereby affirm that 1 am licensed under pmvluions of Chapter 9(anntrcticing
p fez with Section 90(abofDivkion 3afine B.,inesund Prnre.,wraCadeandmy Ee,n.e it RESIDENTIAL
W p I'lIRM1T ISSUANCE:
Fy,�WO� in full torn,and effea7 / " OSFOWL OKI'rCIIIiN RF.MOOIiI.
10U Le'e, ' Irina APPLIANCES-RES1DENHAI, ❑ADDITION ❑PL11MIUNG RE.PIPE
I-Z W Date Con m",n
Xaa' ARCHITECTS DI:CLARATIUN - OMUI:I'I-UNIT OS'rRUCI'URAh
I'ANF,IS MODIFICATION
ZOrhZ I understand my plansshall be used as public record. UP T021MIAMI'S
OZ4)p OINTERIOR [I CHIMNEY REPAIR
(r--+—W Licensed l'mo,sional 201-FXXOMPS IMIPROVEMENT []SWIMMING POOLS
a rJ OWNIFR-BUILDER DCCLARA'I JON
yr`l�'4 OVER list)AM[
❑13A'I}I kIiMOOEh/Rlil'NR DEMOLITION
CC a herebLow, y arrm,tbat nn,,.,:npl Dmn m,cnntra,lor.Lmen.,Law for m,
W3 F folbwing reason.(Semon 703 L5.Business and profession,Crdc Any city or county SIGNS ELECT TRICAL ❑O'1'111iR
y¢ which,its ss a permit re am.amalrtc improves demolish,nr repair any swaum
FLLOJ prion t e I. y the
ppl ial favach pe 'u file asigned statement SPECIAL CIRCUITIMISC.
a�Y.. mesh I Jp n II p tth C t .......s 1' (Chapter 9
apo u'
('"1pesss ,g w'th S '„900X)of DO,i.. 1 rfhv ba, sxs...I roRX: Cdoor I LMP ME'1'ER OR POLE INS'I'. COMMERCIAL
C.W e ae In.,he Is exempt therefrom m l the hash fnr the alleged exemption.Any violullan of ❑NEW BLDG/ADDI'I[ON O DEMOLITION
Section]031.5 by any applicant for a Permit subjects the applicant o a civil penalty of POWER DEVICES OTENANT ❑1001)SERVICES
not more than Eve hundred dollms(5511(16 IMPROVEMENT
—Rs( L:n owner nr the PrnpenY,nr mY enml,yecs with xvgcn u. IM N sLE
F+ will do the work.and the structure is nal intended or of@rtdfar e(Scc.31W ❑OTHIiR
aCcE andl Code:9'1 L t L 1 jus q,ply to u, of ( 1 S WPIC S IX'1'UHPS
5 proper, 'M1 b Id: r 1 th ,a J d , sed elf nr Igo
his own ply provided that h imp c ne a 11 for 1W SI IJ SQPI
sale lL however,the builJmg or improvement,.old within, ref comp SQ.hf.FLOOR AREA SISQ.IT.
awn
er-buildr,will have the burden of proving dist he did nm p fm
pe sc of sale.).
❑ I,as owner of fho property, ra exclusively conaucting with fter s emfmII,1 m - -
metruct the project(See.91,14,Business and Professions C,tle)'@e C,ntrnetof's Li-
ss law Juts not apply total owner afpmpcnY who nuilJs or
improves thcmoae '1'. PLUMBING PI?RMIT PEIi
who commaa,for such projects with a mntmaons)licensed pennant m the Comrnwrs
Lia:nw law. Ii S.' ANCE
lan,cavmptunderSm, .B&PChaillisreason
ACfER-DININ&VENT'-WRI'ER(IEAI VALUATION
Date
m WORnder p COMPF-rvSATIUN DF,CLARATION BA I' OTECT.UISVICIi 0
I hand w illRt uric.penalty d pe jury one of the Gdhre'ing de rker's Co
❑ Ihave send will maintain uCenifcam of Connem muaf-insure far Workers Cnmpen- DRAINS-PLl10R, CONAkDL � r GS '1'1'1'Ii CONSTRUCI'I(1N
ration,as provided for by Section 3900 of the Lanor Calc,lot the perr,nnancc,tlbe 199
rk I'or whlcb this perl,Ihis i.vwcd. FIXTURES: ER'IRAI'
, (I nave and win maintain Workers Coralwa.arm,Insurance,as required by Section
3]1X1 of the lahrr Code,for the permanence ofthe work for which rbi.permit in iouW. GAS-IiA.SY, 1 4OUfLETS (KC.GR EUI' APN
My Worker' CyymPPjjnvU� yy,.JJ�[ r and Policy'yy yy o
Carrier: � 1ltagly Policy No, A101O GAS-EA.SYS TEM-O ER
CERI'1FICA'IE OFEXEMI11'ION FROM WORKERSCMEASI%INUIIS'I RL WAS 11:1N'I'ERCEPf(H
COMPENSA'I TON INSURANCE? BUILDING DIVISION IBES
fur,ocaionnud net bce,mplctcdifthcp,tit inYnnmcbundral d,IlomlEllXIJ GREASE'I'RAI'
PLANCIIISCK FEL
or leas.)
I reality that in the perfannance,I the work for whichthis petit is issued.Ishdl of SEWER-SANITARY-STORMEA.200 FT.
employ any pesos in any manner so as to bmme n w
cs.bjethe Workers'C,mpem ENERGY IPE
'2 Aptiu Laws of Cal'Jnrnin.D:nc WAI'IiR[][:At ER WIVIiN'1'/IE.IiCrR
zQ Apptiuun GItAUING ILL
t,,i Not'ICC'11)APPLICAN E If. f¢r m�kin,fin,CeniOcatc of Exemption,you.should NATER SYS'IEM/IRI?ATINC, SOLI ti PER
7 became subject n,the Workers Compensation prevision,of N,labor Code.you must
forthwith comply with such provisions this permit shall he decreer revoker. WATER SERVICE
y Q PAID
C'ONST'RUCTION LENDING AGENCY NEW RfiSIDLN'I'IAI.PLME. SQ.PI'. )n I""'sA
V z I handy.Mirth dial l here is a memmfion leadingugancy lbr the is,dornwnceof
LL r the work for whahthis permit iv,,wed(Sec.3097.Ci¢C.)
OU 1<nrers Name IOTA /,-.1
TOIAL:
,r LJjLender's Address
f.., I ceaify that I have rear til,appf,,fua and ante that the armed iafnrmution u, BUILDING IFF.
L.� (Qil macer l amide ma,nq,ry wnl:ml eny amt c,rlr:dyardimrnocsalm.ane lawn relma,gm QTY. MECHANICAI,PERMIT {rBIS
U ZbuilJingeor,druction,still hcrchy afahorim mlaceenmtivcs of this city theatth
er upon e SEISMIC 14Ji
ebrwennen...med .,,by lin inspection purposes. VERMII'ISSUANCE ELECIRIC IPE
We)agree to save,indemnify and keep hrmaless the City of Critical against
Buiil'ni,a judgmentsynst.a"dexpen,c,,hichmayi.anyway.c.e.gui.,,,.id City ALTER OR ADD'FOMECII. PLUMBING FEE 0
ina1191nceser granting amnia perm it
APP1 'I" DED D� ' ILL(' MI'LY WITH AEI.NON-POINT AIR HANDLING UNI'I'('fO 10,(XI(ICI'Ml MECIIANICA.IEL
SOURCI' h N . Q
��_,�..98 AIR HANDLING UNIT(OVER RON)CIM) CONS'IRULTION'IAX
Sifname"I'ApplIjewn, Date EXHAU$'I'l1000(W/DUCT) HOUSING MITIGAUON FEL
IIAZIA%AHUOUS MA'1'IiR1ALS DISCLO$l1RE
Will by
a Cul and nr fnmm M1pal Co e.Chapter
Homs and the
har.arduand Safeal IIGA'I'1NG UNIT'(TO IINI.IXXI IITIJ)
as del incl io the Capcninn Municipal Cnde,Chopmr 9.12,send the Ilcalth nnJ Safety
Calc,Section 25512(al) HEATING UNIT(OVER IIX),IXNI ICN)
❑lies "Nu VENTILATION PAN(SINGLE RESID) PAID
Date Receipt p
Will the applicunl or liaum building occupant LIC equipment a devices which Ii011 F.R-C'UMI'(3HP ON 11X1IXXI RTU)
moil buaardiso air canmnnlnanb sidelined by the Buy Arca Air Quality Maragea an I'
D,Mna 9 BOILER-COMP(OVER 100.000111U,
❑Ye. 0 N
I have read the broardous materials tcyuire rem,under Chapter 695,E the Cali- AIR CONDI❑OXER —IS$U/f� X'1171
I'omia Ilvalm&Safety Cede,Sections 25505,25533 and 25534.1 understand that it the NEW RESIDENT IAL MICA. SQ.IT. P I(IY
na ld...g rows ren,an,mly have a tell 1,fhnt h is my resrymvRalhy to aauly d„enadpam
of tiro mquiremcros whin,must be met prior e.issnaaee,r u Cemifi,me of o,uupancy.
Owner or aananed agent ])am TOTAL: ISSUED BY:
OFFICE
x>
• - m
m
0 0 0 3
1
0 0 0
A A A C
CA
N
D D D
r r r C
C) n n (1)
000 1
m
m
m
r
0
x
z
m 0 y
v m
jnz m
T m Z n
0
o O
o c
m
0
a w
D
a
m n
_ v
D m 0
y -D
O O W Z1 m
0 D D 'm
m 1 -
v
_ _ w
• � f N v
0 o m O
c0 m co
mm00 m
000 M
(n (n Cn N
a
m
O
O
C
T d
N
N
on
w
Z 0
O
a
m
O
(n
0
0