7127 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES.- USE BALL POINT PEN ONLY t
13U LDING PROJECT I DENTI FICATI ON - PERMIT NUMBER
SirLDINr. ]� APPLICATION& PERMIT: r n 1 2 7
el-
ADDRESS VTY1L k 46
(1
UI Q BUILDING-ELECTRICAL-PLUMBING'-MECHANICAL
,,4IG1 i.� PLAN CHECK VALIDATION
NAMERa • 'ay'3,'�P=4`da'y'4i'x$L.'� L h
DTV. . -, ELECTRIC PERMIT�sa WWv "4s
PHDNE
CONTRACTORSOUTLETS-SWITCHES-RE CEP 5.00/1.00
n E. m
GLA- �& r LmC.ND.3�p , LIGHTING FIXTURES 5.00I7.00 . JAN 22 1905
ADDRS ' S ' PPLIANCES-RESIDENTIAL 4,00
ADDRESSDRESS
msoNE3�� III PANELS 5.00 rD'a EAP11:10ATJON
ARCHITECT SIGN$ 6.00 PLAN CHECK F .C.NO.
OR
ENGINEER ,
.`SIGNS TRANS. 3.00
ARCH.OR ENa - SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 15.00 / / -
AeeucANrs MOTORS" SEE FEE SCH.
ADDRESS
. SERVICE CHANGE 10.00
w
00 'LICENSED CONTRACTORS D17CLARATION -
a- : I-hereby-affirm that I am licensed under provisions of Chapter 9 e`A( �/ 3.•„]- ) 5 NCE DATE
w (commencing with Section 7000)of Division 3 of the Business and - BLDG. EL PLG. MECH.
wi Professions Code,and my license is in full farce and eflecl.
zO - License Class Lic.Nu + ❑ El ❑'
Z, z F� Date� Contracte,lor - - •
a s BUI eOING PERMIT
m Ica OWNER-BUILDER DECLARATION ++�
cod" MISC.- REFER TO ORD 'q} IN�OHMATION
w g LL 1 hereby affirm lhel'Lam exempt from the Contractor's ygOATION $/FT,
F u m j Low for the following reason.(See:7031.5,limmussand Professions PERMIT ISSUANCE 6.00 /
Code:Any city or county which requires a permit to construct,alter,
IS a,¢ p improve,demolish,Or repair amy slrRelum,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. ���
0,E requires the applicant for such penult to file a signed statement ODIC . IOTA - PERMIT TOli
u w m he is licensed pursuant to the provisions of the Contractor's License
- O
s- Law(Chapter 9(coo me ncing with Section 7000)of Division 3 of t hes .tl 't• "Adu'u# �"y1TrNIVC.q h
i ao Buxmess and Professions Code)or that he Is exempt tficrelrom and QTY. PLUMBINQG{'IPP RMIT FEE
Ic I- the basis for the alleged exemption.Any violation of Section 9031 5 se.. ; 'r6 "3ki, .w L•G STORIES TYPE CON$TR.
1by any applicant for.permll subjects the applicant too civil penally ALTER-DRAIN -WATER IEA.14.00, '
of noCniore than five Imndred dollars($500)):
C) I,as owner of the pmpeny,�or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
their sole compensation,will do lire work,and the structure is not _
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 4.00
Code:1'Iie Contractor's License Law does not apply to an owner of
property who builds or improves thercoo,:md who doessuch work FIXTURES-PER TRAP _ 4.00 SO,FT,FLOOR AREA TOTAL ACREAGE
himself or through his awn employees,provided that such improve GAS-EA.SVSTEM-1INC.40UTLETS 4.00
mems are not intended or offered for sale.If,however,the building
or improvement is Sold within one year of completion,the owner- ' GAS-EA.SYSTEM-OVER 4 IEA.) 1.00 BUILDING USE
builder will have lire harden of proving that he did not build or im - IND CDN PB Omer
prove for purpose of vale.). - - INDUSTRIALWASTE INTER. 20.00 ❑ ❑ ❑ ❑
❑ 1,as owner of the property,am exclusively contracting with
licensed contractors In construct the project(Sec.7044,Business LAWN SPR IN KLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Cade:The Contractor's License Low does not apply - -
lo an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a umtmclurls)licensed pursuant to -
theContractor'sLicenseLaw. - SEWER-SANITARVSTORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ 1 am exempt under See. ,B.&P.C.for this WATER HEATER W/VENT 4.00
reason
Owner Die WATER SYSTEM, - 4.00 ACC.DATE ACC.FILENG.
WORKIiRSICOMPENSAI'ION DECLARATION WATER TREATING EQUIP. 4.00
1 hereby affirm that I have a ceniftcaleofcoment to Self-insure, - ZONING
or a certificate of Workeri Compensation Insurance,or a certified ENG.SITE NO.
n thereof(See.3800,Lab.C.L `
I'nl y . -Company
O Cer ❑cd Spy is hereby r shed. x ' FIRE SPRINK ENERGY RY4
ZO icon tifiedopY files wilco the city'i peclion division. MISC.- REFER TO ORD. y❑ N❑ Y ❑ N❑
w G PERMIT ISSUANCE - 6.00 FLOOD ZONE A.L.U.C.
- 1' 'ICATIi li 1'TION FROM WORKIiRS'•
W D COM 7N IONINSURANCE , PLG.CONTR. LIC.NO.' PLG.
1 O ITh. "choir need not be completed if the period n for n TOTAL Y❑ N❑ Y❑ N❑
� 2 hendrLddon�rs($100)orleys) l'n'. . y �j4y - �,# 'S �'% ky"#J•"1
•i
U O 1 certify that in the performance of the work for which Ibis per OTeY//. r k MECHANICAL PERMIT FEE ! FEE SUMMARY
LL f nit Is issued,I shall not employ any person In any mammy so ms to �&„' Ssp,x '- ';'x ,°• - A�19',
U become subject to the Workers'Conmpensation Laws of Califomma.
Q. Date - Applicant I ALTER OR ADD TO MECH. 4.00 BUILDING
} rn NOTICE TO APPLICANT: If,after making this Ceriificale,of mix- .
? emption,you should become subject to the Workers'Compensation APPLIANCE I 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with - FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1QOODC.F.V0 3.00 -
CONSTRUCTION Lf:NDINGAGENCY AIR HANDLING UNIT(OVER 10=C.F.M.),5.00 SEISMIC FEE
I hereby ifl'irm that there is a construction lending agency tar EXHAUST HOOD(WITH DUCT) 2.00
the performance of Dmf work for which this permit is issued(Sec. - - MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) - 4.00
Lender's Name HEATING UNIT(OVER 100,000B.T.U.)7.50
Lender's Address ELECTRIC
1 certify that I have read this application and Suite that tire above VENTILATION'FAN (SINGLE) 3.00 -
information is correct. I agree to comply with all city and county PLUMBING
ordinances and stele laws relating to building construction, and BOILER-COMP(3 H.P.Dr 100,0008.T.U.) 4.00
hereby authorize representatives of this city to enter upon the BOI LER-COMPdOvar 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes. _
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. -
Cup im, against Iia!"tiex,judgments, costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
M4. i any way a to against said City in cons quence of the
anti of(his pen it. • MECH.CONT. LIC.NO. MECH.. ,,. 4faro t
a TOTAL I k
z TOTALt
S' etureofA tic Contractor Date
OFFICE COPY -