5537f
- APPLICANT TO FILL IN'INFOR;JaTION WITHIN RED LINES =USE 13; ' OINT PEN ONLY
- BUILDING PROJECT IDENTI FICATW
APPLICATION &PER
BUILDING - ELECTRICAL= PLUMBING - MECHANICAL
PERMITNUMBER ,
. .
5537
.BUILDING
f�yY�p
OTANER'S
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tow �/YJ PHONE JJ -(
-
OTY.
- -
- ELECTRIC PERMIT
-
FEE
PLAN CHECK VALIDATION
�• `
DATE OF APPLICATION
CONTRACTORS
NAmE Z��Op
LID, No
0'/ 5
OUTLETS = SWITCHES - RECEP 5.00)7.00
70
/1.00
LIGHTING FIXTURES' 0
rONTRACTORS
ADDRESS - p
10Z ID /T: I/ PHONE S i0U
APPLIANCES- RESIDENTIAL 4.00
-
PANELS " 5.00
SS-
ONRCHITECT '
EGINEER
N
' LIC. No,
!
SIGNS , 6.80
,
PLANCHECKFEE
SIGNS TRANS. 3.00
ARCH. OR ENO -
ADDRESS
-
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
f .'
EMP. METER.OR POLE INS. "„ 15.00
ZIP
ADDRESS
MOTORS FEE SCH.
SERVICE CHANGE. 10.00
VVV
LICENSED CON 'r RACfORS DECLARATION
1 hereby allied that 1 am licensed under rmsisionsaf Chaptm9
(commencing w Section 7000) of Division 3 of the Business and
I'rofcsslons Cod au1d pry license is in full furl atQl'Jf
Licenu Class I Lic. Number -) / v/
Dole q�A1._.p Contracor
OW F DIR UECJnM
I B
I hereby a llovilliat I on exempt from the Contractor's License
Law for the following R.• eson.( SeC .7ires a j Buainecsand Professions
Code: Any city or county which rdquiresa permit toconsua c alter,
also
requires the applicant for such permit to file a signed slalement that
requires demolish, Or fia,m any Slrnr 1. f, prior n ) s issuance that
lie is licensed pursrl:ml to llrn provisions of the Contractor s License
Law (Chapter 9lcommencing with Section 7000) of Division 3a fine
Ilusiness and Professions Code) To that be is exempt therefrom and
'ISSUA
BLDG. ELECT. MECH,
r
BUILDINCrPERMIT
I F R TION •
-' .
MISC.- - , .REFER TO ORD
^
VALU 1
r
/eZ J 6 a
/
_
PERMIT ISSUANCE 8.00
'-
-
ELEC. CONTR. LIC. NO.y ELEC. %/
" - TOTAL
CITY. PLUMBING PERMIT FEE
PERMIT TO
'plAsIG[6 MtL
STORIES
. TYPE CONSTR.
the basis for the alleged ex em pl ion. Any violet ion of Section 7031.5
by any upplicunt for a permit subjects the applicant to a Civil penalty
of not here than five hundred dollars ($500).):
'ALTER
-DRAIN IL VENT-WATER (EA.) 4.00
❑ I, as owner of The property, or my employees with wages as
their sole comperocarm, will do the work, and the structure is not
intended or offered for sale (Sec. 7044, Business and'Professions
Code: The Contractors License Law does not apply to an owner of
property who builds or improves thereon, and who does such work
himself or Through his own employees; provided that such improve
ments are not intended or offered for sale. If, however, the building
BACK FLOW PROTECT. DEVICE 2.00
O/�jG. GROUP
RE&. UNITS
DRAINS - FLOOR, ROOF, AREA,COND. 4.00
FIXTURES - PER TRAP 4.00
GAS - EA. SYSTEM -1 INC. 4 OUTLETS 4.00
a
SO. FT. FLOOR AREA
� �/.i0
TOTALACREAGE
'
or improvement is sold within one year of completion, the owner
builder will have the burden of proving that he did not build or inr
prove Do pmpose ofsalc,l,
❑ 1, its owner of the property, am exclusively contracting with
GAS - EA. SYSTEM - OVER 4 (EA.) 1.00
BUILDING USE
11��ES IND CON PB OUT.,
FA\ C1 Cl 0 ❑
LLLLJJJJ
INDUSTRIAL WASTE INT 20.00
licensed contractors 10 c0mtnmt Ore project (Sec. ^.7044, Business
and Professions Code: The Contractor's I.io nse Law does not apply
to un owner nl' property who builds or improves thereon, and who
LAWN SPRINKLERS - 1 IN .B, 5.00
LAWN SPRINKLERS - OV R ( b. o
-
ASSESSORS PARCEL NO.
3
contracts for such projects with a co ntractor(s) licensed pursuant to
the Contractors License law.
SEWER- SANITARY- OOft /6.00
TRACT NO,
PARCEL NO_.
❑ I um exempt under Sec. - , B. &P.C. for this
reason
WATER HEATER W /VENT Cf}(1m
Owner' Date
el�
WATER SYSTEM 4.00
y, -
ACC. DATE
ACC. FILE NO.
WATER TREATING EQUIP., 4.00
wORKERS'COMPENSA'I'ION DECLARATION
' I hereby affirm that I have a certificate of conaenl to self- insure,
or a certificate of Workers' Compensation Insurance, or a certified
-
ZONING
ENG. SITE NO.
copy the.,,( (Sce.3800, Lab,C.).
Policy Nn. Company
• Certifed copy is hereby furnished,-
• Certified _copy is filed with the city inspection imsiom
Applicant -
FIRESPRINK
'Y N
ENERGYT-24
Y N�
MISC.- REFER TO ORD.
C F R'1'11s I CAT17 01' EXEMPTION PROM WOR K Ii RS'
PERMIT ISSUANCE 6.00
FLOOOZONE
A.L.u,C.
COMPENSWION INSURANCE
(This section need not he cam Ieted if the permit is for one
himdrml dollars IS 100) or Tess.)
PLG. CONTR. LIC. NO. -
PLG. r/�qt'9q
TOTAL V 4,1�
Y ❑ " N ❑
Y O NE]
"
1 certdy That in the performanc of the wor fo Iiclr this per-
nit is issued, I shall not employ ny pars r 1 ar tarn so as ID
becoq(tr�c
_11-2 he Workers' s pen. o L' s fC iforan.
D:neAJ LApplicant
dr1CI> "1'O APPLICANT: II', after a ing 'ettificale of Fx�
emption, you should become subjee o The Workcts' Wmpenmtion
,provisions of the Labor Code, yo must forthwith comply with
such provisions or Ibis permit shall be deemed revoked.
CITY
- MECHANICAL PERMIT
FEE
FEE SUMMARY
^
BUILDING
ALTER OR ADD TO MECH. 4.00
APPLIANCE 4.00
'�"
PLAN CHECK
FEE
AIR HANDLING UNIT (TO 10MO
3.00
AIR HANDLING UN 10
.15.00
SEISMIC,FEE
• - CONS' I'RUCfION LENDING AGENCY
EXHAUST HOOD (WITH DUCT) 2.00
�-•
I hereby affirm That there is a,comtruction lending agency for
the performance of the work for which this permit is issued (Sec.
3097, Civ.C.). •
MICROFILM
%_
HEATING UNIT ( 4.00
HEATING UNIT (OVER 100,000B.T:U.)7.50
ELECTRIC
/
(�?
Lender's, Name
Lemlcr's Address
1 I ccitify that l have read this application and tram that the above
information is correct. .I agree to comply with all city and county
mrdinances and slate laws relating to building construction, and
VENTILATION. FAN (SINGLE) - 3.00
PLUMBING
p
O '�
. . .q
BOILER- COMP(3Ii.P. Df 100,000 BTU) 4.00
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
q e�
hereby authorize representatives of this city to enter upon the
above- mentioned property for inspeclion purposes.- "
(4-` gree to save, in mnify and keep harmless the City of
Cup against. lie 'li' judgments, costs and expenses which
may ny w" a c agar t mid City in consequence of the
granf thi cr lit
0 _Z 4
MISC. - -' REFER TO ORD.
-�
-.
CONST.'TAX
•PERMIT ISSUANCE 3.00
MECH. GOVT. LIC. NO.
MECH..
TOTAL' 4 q_
�l
TOTAL
96S d
Signatur pplicanl /Contractor Date
OFFICE COPY