B0350 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITYOFCUPVISION BUILDING-MECHA ELECTRICAL / O350
BUILDING DIVISION APPLICATION/PERMIT PLUM1IHINC-MFCIIANICAh S0001
BUILDING PROJECT'IDENTIFICATION O ANTI
HUIIDING AIIIIRIS���� S. T�� SANITARY NO. APPLICATION SUHMI'ITAL DATE
OWNER'S NAME: PHONE' CONTRACfORJN E LIC NO', C lo -9 ?
f eri! ` Gp i7o 9.1 WC DN KOI.ft
:�ARCHGECTIENGINEER: LIC NO: ADDRESS: I f/ti 9(`ILS' ❑
2+0 J;wj .Tori
FC�O��A�� PHONIC BUILDING PEM IT INFO
��_ / YAP _J Z 9 2-Y ❑ ColLwlu int Feer Paid by Applicant(Initial) BLIXi IiLECT PLUMB ME❑CH
LICE�NEA
1U))CCOO/NTRAC OR'S DECLA/ A7T10N7 7 QTY ELECTRICPERMIT FEECEJ(y eIBmI Thal 1 am licenced under pruvui^nA M Chyver 9(commencing JOB DESCRIPTION
"ZXM1)nf dvixhmJuf NU Bueirmcs vtd onmC" c,.rdm'faemsiv RFLIDFNTIAwon PERMIT ISSUANCE
CBm OSFDWL O KITCIIIN REMODEL
ULc'X APPLIANCES-RESIDENTIAL OADDITION OPLUMBINGRE-PIPE
NEL Dalc Cap ❑MULTI-UNIT 05TRUCNNAL
ARCHfIF,CPS DF.
p,p y kg*rPANEI S MODIFICATION
Z O�2.Z. umkr4mW my plunx dull be u.vud v puM1lb record,
UP TO 21X1 AMT'S
D
02-0 INTIiRIOR OGBIMNI!Y REPAIR
g,vt F-LL: Lianscd Profasioad 281-1000AMPS IMPROVENIENT OSWEMMING POOLS
OWNER-BUILDER DECLARATION OVEN 1000 AMPS 0 BATH REMODIJAEPAIR 0DEMOLITION
C I hfriml Th
ereby ual I am eamu,n Trent tle Contractor,Liccncc law foth
I,,, e
L U Billowing mason.(Section]131.5.Bminc.s.td Ponfevuout%GXb,Any city or courty SIGNS ELECTRICAL ❑OTI WE
W 31y N which requim.permit to cauwet.Our.impm.r,domotoy.or repair any stmeace r=
f-LL� Prier to I.issumec.atm Acquiree Nc applicant facsltcn permitla file..tipoM stvcmrnt SPECIALCIRCUT ISC
y>A� but hcixk—sd ptusuam to prop m,,kiur1.fthc Cortm,mh Lccme Law(Chulo'c'
a�p0z 1<omtmmm�y with 5¢linn 9fXp)o[Uvil:ion30(lee Huxinca and lYnf�izionv Ctdd or TEh1EMITERORPOLEINST. COMMERCIAL:
a a e LL flus,Ke La nempt Ihcrcfrom and the nu.for tbu v11,ed cvemptirn.Any vinlaiun of ❑NIiW HLDGIAUDITION ❑DEMOLITION
-rn SmiOo]BJ1.5by.ny epplic.nt for a Permit wbjeels the applicant to a owil penalty of POWER DEVICES OTENANT CI FOOD SERVICE
m.mote than Ave nunmrd dollar.(x3101. IMPROVEMENT
�ZQ Ol,mnwier of thePm'rty.nrmy em'],ce,with wmpcv oclheir sob mutp.7txution. SWIMMING POOL ELECTRIC
Fp ❑0'I'f IIiit
will de 0e wore,and IK wucture is rot intcrldW or oBi�cd for.Wc ISs.]Did.Husinc.s
nil end Pmfesrinns Code:The Contractor's Lieem.law dies not apply to ao acinar of oCTLE-s-SWETcHES;-FI.CNRFS 4
63^ p^geny wlei hands°r impvva tbemun,mind who dcoA. h mood himclf a through -
11,
li
his men mn,loycw.Pmvidul thlt each ilnpmvenenle ea nod immood ur offmcd for NEW RESIDENTIAL ELECT SQ if.
wlc.if,hmweventle holding err imPmvrntem u uld within on,Yew of conyrletim.l he SQ.IT FLOOR AREA $NQ.IT
na-Ivilder will dive Etc burden°f owing that he did nu buiMl rx imlmAe for pu-
pre M uk.),
0 L as ret of tnc ptopcny,am exchokely contracting with licensed common-to OT
axsuuct tic prvjeci(.Seer 70i4.Bvsincwn co Trnft Code:)'Iia:Cmtumr's Li-
ccnsclawdxa rotepplymun owtl¢of fXgeny wMi nmBJsmimpmve lhnam,erd QTY PLUMBING PI?RMIT FEE
.M.forstcn pmjectcwith.'ar arrosfs)licensed o doom °the Codrecld. D Q
Lic¢oe Lw. PERMIT ISSUANCE
0 I am rxanpt umler Sec. ,11&P C for Ihis realm
ALTI:N_DRAIN&VtNT_WATEH(EA) MAY 10
OV,199'()N
Ower he r
WORKIkc, COMPENSATION I"ofdoon DECLARATION BACK FLOW PRflIF.CL DI!VICE �(
thereby al arm under PwwllYofterjuryrule of oc j"ur hTWcdm`,xCm. '1
(] Ihave gmol ooidel fiX by.e Ccni hcac Of Gonccnno relf--in sum Lr Wrmor'n Cwupcn- DRAINS-ELIXIR,H(bF.ARIi0.COND. S'IppI1LG pl?CONSTRUCT'ION
.etim,u prichdin fIX by Smiea d. of the lade Cat,for the PrdorrturcC of the Com/
work have
whim Nl madinit is i.wal. MIXTURES PER TRAP
0 I M1avli oat will aoc,for a PeK's an" i lion Inwmncc,as rn, m by 5¢m^n
B]IXI oftlxaaMir Ctdc,liinhc perGxnwncc of the work for which reit pcmtit iv c.uel. GAS-IA.SYSTM-I INCA OUTLETS (ICC.GROD "ter' - APN
My Wcdacra C'mpen,main In..coni¢;md Puliry oumhrr arc:
Carrier. PMky Nu-: GAS-E.A.SYSTEM-OVER a(2A)
CERTIFICATE OF EXEJ IPIION FROM WORKERS'
COMPENSATION INSURANCE GRFASMNDUSTRL WASTE INTERCEPTOR BUILDING DIVISION FEES
(Thi,wrlian nml not de complclN iftho prnnil iv fm nim hurdretl dull-($100) GRIASI!TRAP
or kers) PIANCHECK PIJ!
Ice '- Oe p¢fmnmtce.the'v for whicb Ibis Pcmut fsiswcd.I shall SEWER-SANITARY-STORM FA.2O FT.
nM cm nny perm mnermas to heconto wheal to the WnrV-.rn'COapen- ENERGY FEB
O Z motion Callf I to WATER IIIAITR WNI!NI'/I!LI!CI'R GRAVING FET!
Appi t
y NOTICE CA In maWrrg this Cmafi iae of Exemption,you should WATER SYSTEhf/IREATING
�` navittrc. s or,Compwwlim pnivi'mm,Of the labor Code.You muu SOUS FEE
fonhwi nuntPly wiN.nh prnvixiau trc this femtit Nell be MvmN rovuked WA'117R SERVICE?
0
7Z CONSTRUCTION IENDIending :CY NEW'RESIUFNTIAI,PLhttl. SUIT. PAID Due
U O ,fmrew which
tthmm"I iss.ctl( oo .30Aaction P,CEng eE¢cY for de pcdmmancc of
W �-. Lo work hrc which Nix pcnnit is Ixsu J(.Secs 309],Civ.CJ TOTAL:
O H ICM¢'.s Name TOTAL
} Qj IrirMsMBUILUENGFE
1 ttinndyify tMi l neve Arad acs applic°tkn and....Nw Inc oboes ipfunrutien is
In cvncet.l agta to cmlPly wiN WI city mrd mumy ixdirlmtre.erd smote kws relaing m QTY. MECHANICAL PERMIT FEE
U Z building a°nWmctf°n,mrd hereby aahorirc mprexnlalivcl uftink city locuter uptan the SEISMIC FEE
elxivu-mcenoodd goer ty Ter insprctinn mrou,, PERMIT ISSUANCE
(Wr)e to save.irdenlnify and keep bnnla.Ne City M C'mourmegoiost ELECTRIC Til:
liabilities ' gmcn is ad expense%which may in any way Atecole egeinet mod City ALTER OR ADD TO MECH,
un 'ovine" the of this Pcmtil PLUMBING FEE
APP CANTUND WILL COMPLY WI'lll ALL NON-MINT AIR IIANDLING UNIT(TO 10.000CFM1 MECIIANICAL
SO CEREG
kp/J
w�/M AIR HANDLING UNIT(OVER 10.00 IM) CONSTRUCTION TA
Signmwe MAPp)IC VCtmirectIX Date PXIIAUSTIIO0DIW/DUCI') HOUSING MITIGATION FEE
HAZARDOUS MATERIAL-S DISCLOSURE
ME IM emlicrtmOrname building occupant Rorc or hount humdras mtimal REATING UNIT(To 100.1100 BTU)
ac defnnl by the CuPcninu Murneipol Cak,Cheptef 9.12 and the H-Ilh afd Safety
Ctdc.Scelinn 25532(N? EATING UNIT(OVER l(X)LXX)BTU)
DY" VI3NULAIlON FAN(SINGIX RPSIU) PAID Dem R¢ciptM
Will the epplicam or furore buh,mg uccupma gyre equipment a dcvim which
mil harallouanircummorinena nsdehtedby the Bay Area Air Quality Management BOILER-COMP OR 00.ro0 NTD) OT
4Ddeare,I BOILER-COMP(OVER I IX%00f BTU) v
❑Yes L'JNn
havcrradt hand aman", baekr Cn fi95.the Cali- AIR CONDITIONER ISSUANCE DATE
ryuin pt¢
f Ilcallh&SWmy y .SMitxIx 25505,25593 anal 255W.1 uMcmwW that if the NEW HFSIITIiNTIAL MI!CII. SQ.Ill
'ngdcs nct Inv otTEen ' my re 4 a Cor,fiodl of the n¢vpam
Ile reyuvm int c ac inn prior rm inn prior to�¢.e C¢tiflcet.of Occufarcyof a C¢tifu�et.of Occufatcy.
O �ugcnt Ilam TOTAL: ISSUED BY:�~
OFFICE