99070086 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITERSN
CUI'F.RTINO BUILDINC-KLVC'VRI CAL I'I.
IS UG DIVISION APPLICAIYON/1"ERMI7• I'LUhIItINf.-MRDEN"11FIC
BUIhUINI:I'k(IJI:C'1'IDB\-I'IN'ICA'I'IUN
BUILDRESS: SANITARY NO, API UCAI[ON SSUUHNU I IAL DATE
EAME. Z "` I3G � coNTxADON W I 3z — z
6`3�WHARWOOD ROAD N/` `1x`"01"
MAR IclCHffliCl'AN NEER: LICNO: ADDRESS: 32 ❑
377-2323
CONTACT: PHONE: 6UILDING WITINFO
❑ Consultant Fees Paid by Applicant(initial) xO; lil.e('IPIAB MMfi
❑ ❑l
`MCI NS UCCOONTRAC'FORS DLC`ARAI'ION Qpy Ii1,ECTRIC PERMIT FEE
I I -ny H don 1 licensed n J p ,m(J D n ma s J013 DESCRIPTION
Aaz wilhS I 700X6 tll : 3 Itl Ih:sin dP f'si+ 'C 1 yin"n RFSIDEN'11AL:
I'ERMI'f ISSUANCE:
CO- adlfmrcn 1clln _1O eL O� ❑SIUWL ❑KI'I'CHEN REMODEL
<—U License Cl, s hlek C APPLIANCES—RESIDIIN'UAL ❑ADD]TION ❑PLUMBING HE PIPE
v-Ga U:nc Clno-acT°r ❑MULTI-UNIT ❑SrFRUC'I URAI.
A RCHI'11i6r'S DECLARATION,Dln PANIiLS MODIFICATION
z Oa,rZ I understandmy Ilam shall he used a,Public recnfde I UP 1M 21X1AMT'S
OZ—,J ❑INTERIOk [I CHIMNEY KI7PA1R
F:,vl Fty Liccmcni Proteadonal 201-iNX)AMPS IMPROVEMENT [:J SWIMMING POOLS
CYOWNER-BUILDER DECLARATION OVER INX)AMI'S ❑ {ATI`RENIODEI/REPAI OD' OOLIITION
C C Q 1 hereby sill.Iha(1 am exempt from(he Cmaomo,e,License Law for the �OTHIiR � � l��U\
Icxj 3 E following reason.(Semon 703 LS,liminess and Podessions Code.Any city or county SIGNS EL[CIAICAL
which y pc i(( c ( I I pm' demolish.h repair ystructure
NQ] prion t L,requiresth ppl Tf such pe ( fl 6 J.temment statement SPECIAL CIRCUIT/F11SC.
�.
that he licensed pa n the provisions ofthec I tor's Licenw,La.(Cnapmry COMMF,RCIAI:
1+100 (Connection,wthSection7000)of Divisam 3 ofthe Business and ProfessionalCode)tar TEMP.METER OR POLE INST.
a a e z that he is lean,,therefrom and the heals for the alleged exemption.Any violaioo oI ❑NEW 1{IDC/ADDITION ❑DEMOLITION
Section 70315 by any applinn(for a permit subjects the applicant to a Civil Penally of POWER DEVICES ❑' ?NANT FOOD SERVICE
it"C 11
not more than Eve hundred dollars($500). PROVEMI?N'f
AEC C] Lmnwncrof the prolvedYatoy employee,wh wa
ilges ax their sole compensation, SWIMMING POOL.ELECT RIC
A will Jo the work,:mdtnc,wdca,is nofmmnJNoro(mrcl fiorwlc(See 71N4,Broincs, O'THlik
w anti Prateminns Code'ILc Contractorm's Liecnlaw does sol apply le:m owner of OU"1 LIiT5—SIV I'1 GHES—I'IX'1'Uk1iS
0. ^ property who builds or improves thereon,and who it,,,,Xuch wad 6in,tal'or through
his awn colpoyec..provided(hat such Inmpmovemenm me not imendul nr ol'tited for NEW RESIDHN'IIAL HIJ!CI'It Sad I'll
SG PT'.FLO(Ik ARBA SISQPI'.
nle.11,Inwuvcr,the nuilAln6nrimprovement is salt within one year ofmnvocloom.(hc
cohnitk r ,It have 0a bunko of Proving that be did not build or Improve far pur-
ry+¢nfsle). 'TOTAL:
I,as owner of the property.am exclusively contracting with licensed contractors m
,,..eruct the project(Set.]xM.Baines and ProfessionsCoJe:)']lie Contractors Li-
close Law does not apply((I an owner of property who builds or inmproves thereon.ant PI. P M F J
who aannas for such pmjcas with a contracmrts)licensed pursuant to the Commctor f
License`., p 1 'U E
1 am excnmpt under See .It k P C fordo,teas:
A.TER— &VENT A'I (VA) VALUATION
Dane
vac WORKER'S COMPENSATION DECLARATION BA CK ROW PR(TIECI'.DEVICE
I hereby axiom under penalty of perjury one of the following Jeckmainns:
]I have and will memento a Certificate of Consent to self-inure for Worker'sGTol'o- DRAINS—FLOOR.ROOF,A R HA.C(IND. STORIES TYPE CONSTRUCTION
moon,as provided for by Section 37W of the Labor Coda,far the perfnmmence of the
w
all far which this perms C Issued FIXTURES—PER"`KAP
I have and will maintain Wake",Compensation Insumn.,as myuimd by Section
.7 of the l.xhar Cnit for the pert mnmc..f Thuworkfmwhichonspcm itisissneJ GAS—EA.SYS"TEN-I INC.,OUTI.I?LS OCC.GROUP �1PN
nope Cions nsur ,thee and l'nGcy numbA uJs,.tr ill f/
My Wor m 4`t Ce35L7/ GAS—EA.SYSTEM-OVER dll?AI
Gn'rier: Tolley Na�y O / O
CHK'I'I FICAHE OFEXENVINON FRIM WORKERS GREASE11NOUS'IRLWAS'IL NERCHVIOR
CUMI'IiNSA'UON INSURANCE BUILDING DIVISION FHES
1'f....aadonnced nut be campOrcJlittle pmol('boon hunAixd Aolbve(5 l(g)) ORE ASETRAP
I'LANCHECK FEE
orless.)
Toy Tiny(bmin ificn ofthe micnthiapvnniomC,'Coan,rll SEWER—SANITARY—SHINN11iA.2lX1I'I'.
nn(
employ vny Penns in any mvnner su as m become subject m(he Workers'Cnmpco- ENERGY Illi
Z union laws Of Cut,tornio.Dec WATER HEATER W/VENI'/IJ.ECIR GRAVING FITH
O C) Applwara
'Zo.l y
1,01 ICI:TO AI'1'LICAN'C If,,face making this Ccrifican of Ftmornam,you should WATER SYSTEJsVTRI:AI'IN I SOILS FEE
? M:emoc subject a,the W..kcr's Compensation Provisions of The Labor Code,you mast
forthwith Comply with such provisions or this permit shall be deemed mvokN. WATER SERVICE
0PAID
GONSTRUCIION LENDING AGENCY NEW RESIDENTIAL P1.1,113. SQ.I7. Dae Receipttl
U O l hereby alRnn that hem is a consuuaicn lending agency for the performance of
F-I the wad fill which this Pd
ermit is i...c (Set.3097,CO.C.) T(YI'AL:
OU LrnJer's Name TOTAL:
N U 1,CdCr's Address BUILDING FHT?
ly I certify that I huvc rad his application and state that the al-se In1"ommhon is
Ftq Correct.l agree loomply with all city and county oo immces and state laws relining n+ O'1'Y. MECHANICAI,PERMIT FEE SEi1SMIC PCI:
U Z bnddingcnnslooreao,amt la,mby:m(nonve ropresemafives ill'this City mental Upon the MIAI PLKMI'TISSUANCE 7• Z(WJ6 (,a I fy dk Ph' ss the Cty fC (inray'mm(liabilitesJyms m,.oq.Iit,dens 1 h y" rtyw y 'y' at laid City ALTER OR ADD'IO MITCH. :nseynence ill the granting ofthis permit.
AI'PLI 'AN'r UNI - "LANDS AND WI CONPI.YWd IAt.I, ON-1'r NT AIR HANDLING UNII'(1010,IXX)CFM) FEEL'CIi ItGGlll..'1 ) pflV4ysNRIIANDLING I]NI1'(OVIiK I1LgNICFM) N'1'AXnmum of pplicunVCnnmeeln IAm EXHAUST I{(R)D(WNUCI') GAI)ON l lilt
HAZARDOUS MATERIALS DISCLOSURE
Will(heapplican(ur!them building occupant s(orc or handle nnandotsmatcrell HEATING UNIT(TO 100.001 IUH)
as Jefined by the Cusanno Municipal Cute.Chapter 9.12.and The Ileal@ and Safety 14EATING UNIT(OVCR 1(0,1X10 ITPH
Gxle,Section 25532(,)7
C]Ye, yJTSu VENTILATION 17AN(SINGLE RILSID) PAID
+` Dar Rrrdr(x
Will the applicant or!marc building occupant use equipment or devices which BtILEK—COMP(JHP OR 100 MI IITUI
nliT havardous air contmnlnans as defined by the Bay Arca Air panllD hfanugemem 'TOTAL:
Dis ie BOILER—COMP(OVER MJXX)HTU)
Cl Yes YI No
�� AIR CONDITIONER ISSUANCE DATE
Ihuve muJ(bc hvunlnu,m:nerials rrgnlnmm�(x under Chapter 6a05 of the Call- G(J /7f
forn..IIcaIIM1."C",
Snl'n mx,a.Scaions 25505.15533 and 2`534.I unticmmnJ that If the NEW kxSIDIiNTIAh MliCll. SV.I'll x
hail :gJ+wet Con uu ' n Io:ve (cnnm, mit mspmcsibil yal nnlify I+CUC'lient
ol'thu crosw ' m: T 1
X , TOTAL'.
O m rout cd agco( Uom 1 ISSUED 11 V:
T OFFICE
l ,l