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8353 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LDI NG PROJECT 1 DENTI FI CATION PERMIT NUMBER BUILDING APPLICATION APPLICATION & PERMIT 8353 ADDRESS BUILDING-ELECTRICAL-PLUMBING -MECHANICAL OW E s A ID, PLAN CH ECK VALI DATION NAME OTY. ELECTRIC PERMIT FEE ONE CorvTEAcroEs NAME UTLETS-SWITCHES-RECEP 10.00/1.00 Z Z, ILIGHTING FIXTURES 10.00/1.00 sox [APPLIANCES-RESIDENTIAL 4.00 ADDRESS 'r ss G^ 'HONE _ PANELS 10.00 DATE OF APPLICATION ARCH ITE T PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0. OR ENGINEER FIG.No. SIGNS TRANS. 3.00 Anna" OR ENG, SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ADDRESS ZIP TEMP. METER OR POLE INS. 20.00 / Avvucnrvrs MOTORS SEE FEE SCH. ADDRESS J SERVICE CHANGE 20.00 C o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30-00 1 v L I hereby affirm that I am licensed under p,Eei,ious of Chapter 9 ISSUANCE DATE (commencing with$eelion 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. Fw i Professions Code,and my license is in full force and effect El ❑ El Z o m - License Class C T� nsE- Lis.Naber _ O 11at F o c - Contractor o � BUILDING PERMIT w OWNER-BUILDER DECLARATION - INFORMATION w3 u r 1 hereby affirm the 1 ant exempt front the Contractor's License MISC.- REFER TO ORD uoJ Law for the folowingreoson.(Sec.7031.5,Buaine"Ind Professions PERMIT ISSUANCE 10.00 VALUATION . $/FT. � - 0 Code'.Any city Or county Which requires a permit to construct,alter, EE 2 ¢ p improve,demolish,or repair any structure,prior to its issuance,alio ELEC.CONTE. LIC,NO. ELEC. IfA, g c LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO of m he is licensed pursuant to the provisions of the Contractor's License E. z i Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe .1L p x Qo 'Business and Professions Code)or that he isexcmpt therm efroand DTV. PLUMBING PERMIT FEE r U r.o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. aim by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than live hundred dollars(S500).): ❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEV ICE 4.00 their,sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 ' Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who docs such work L FIXTURES-PER TRAP 5.00 so.FT.FLOOR AREA TOTAL ACREAGE • himself or Out intended ownemployees,for Sale.if.hd tleatsuch improve- 'GAS-EA.SYSTEM. 11NC.40UTLETS 6.00 himse are not intended or offered for sale.IC however,the building or improvement is sold within one year of completion,the owner- GAS EASYSTEM.-OVER 4 (EA.) 2.00 BUILDING USE builder will have the b Nen of proving that he did not build or ire- . RES IND CON PB Omar prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner of(lie property,am exclusively comracong with ❑ ❑ Cl ❑ ❑ licensed contractors In construct the project (Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Ca lc'.'1'he Contractor's License Law does not:qrp ly to an owner of property who builds on improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM, 5.00 ACC.DATE ACC.FILE NO, WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affl nn that I have a certifi,fue of consent to self-insure. ZONING trr a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO. copy thereof(Sec.3500.Lab.C.). Policy No.-Company . O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z 2 ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. O Applicant _ v❑ N❑ Y E] N❑ N CERTIFICA'I'F 01'EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.UC. LU > COMPIib ION INSURANCE PLG.CONTR. LIC NO. PLG. p Z (This section need not be complete,] if the permit is In, one TOTAL Y[:] N❑ Y [DN❑ hundred dollars($100)or less) U O 1 certify that in the performance of tine work for which this per, OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued.1 shall not employ any person in any manner so as to O W become subject to the Workers'Co pe sation,Laws Dt'C icor n Date Applicant �� ALTER OR ADD TO MECH. 5.00 BUILDING Y } to NOTICE TO APPLICANT. if, iTter milking th s i t ate of Ex- F Z eruption,you should become subject to the Workers Compensation APPLIANCE 5.00 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 100000.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance rf rcance of the work for which this permit is issued(See. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)Lender's Address ELECTRIC ' I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 • information is correct. I agree to comply with u11 city and county PLUMBING ordinances and slate laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives Of thix City Io enter upon fhe BOILER-COMP IOver lOO,ODO BTU)SEE FEE BCH. MECHANICAL above-mentioned property forinspectlon purposes. (We) agree to save, indemnify and keep harniltss the City of MISC.- REFER TO ORD. Cape,ino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in consequence of the granting, fthis'p,,T. MECH.CONT. LIC.NO. MECH. x / TOTAL TOTAL "94 Applicant/ on tract r i )ute INSPECTOR COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BJJILDINGPR04ECT IDENTIFICATION ` PERMITNUMBER pmt. ING . . • APPLICATION & PERMIT . aoOREss - —{ 8 D BUILDING ELECTRICAL—PLUMBING MECHANICAL J NAMERs olF k,p4 , W 4#Tky YL x A PLAN CHECK VALIDATION Q.TV9 4 'y}, g "ELECTRIC PERMIT 3a 'S• I FEE GW � fPHDN F '6 t t A �#'/'' ` i3 3� 9 i•. +i i" NomERacroes OUTLETS-SWITCHES-RECEP 10.00/1.00 II,•� IC.No. 53' LIGHTING FIXTURES 10.00/1.00 ADDRESS TOR's PPLIANCES-RESIDENTIAL 4.00 tC k PHONES —%J-0 ' PANELS - 10.00 DATE OF APPLICATION AMA—'gPANELS (OVER 200 AMP1 20.00 PLAN CHECK FEE. P.C.No. ENGINEER LIC.NO. SIGNS TRANS. 3.00 ' ARCH,ons ENG' SPECIALCIRCUIT 5.00 PERMIT VALIDATION 'ZIP TEMP.METER OR POLE INS. 20.00 A '• - MOTORS SEE FEE SCH. ADDDRESSDRESS f (/ SERVICE CHANGE' 20.00 �G E w o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 / � a S a i w p 1 hereby affirm that I am licensed under provisions of Chapter 9 o'0 ISSUANCE GATE (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT.y i Professions Code my my i is in full force of MECH. c ❑ ❑ G. ❑imo License Class � L V Con Numbe u,r Uate Contractor 6 Y E J ¢ ¢ w¢ OWNER-BUILDER DECLARATION iE'1 BUILDINOPERMIT/ ' 5 ° ' " MISC.— REFER TO ORD +a ,. INFORMATION` .•, : I,hereby affirm thahl am exempt from the Contractor's License F u o J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE1000 VALUATION 3w0E Code,Any city orcounly which requiresa permit to construct,alter, . ¢ ¢ al 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. a O ¢ requires the applicant for such permit to file a signed statement that TOTAL w he is licensed pursuant to the provisions of the Contractor's License PERMIT TO r z r Law(Chapter 9(commencingwith Section 7000)of Division 3 oftlte FEk"s �� 4 o Business and Professions Code)or that he is exempt therefrom and OTY.? a PL`UMBING'PERMIT "# a 5: k t ¢ r o the basis for the alleged exemption'Any violation of Section 7031 5 »% a - �' ` . v ?', S a t§ N: Qju STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant too civil penally ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($500)J', ❑ L as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 - their,sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 r - Code:The Contractor's License Law does not apply town owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOfl AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. ments are not intended or offered for sale.If,however,the building I GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 builder will have the burden of proving that he did not build or int- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. ,'30:00 RES IND CON PB Omer - ❑. I,as owner of the property,am exclusively contracting with PL..._. ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- I INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVE jfij!I E'A.l) (-1.00' - contracts for such projects with a contractors)licensed pursuant to ' the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec. ,B.&P.C.for this 1 WgTER'HEATER W/VENT City of r reason Owner _ Dale WATER SYSTEM • 5.00 ACC.OATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 ' 1 hereby affirm that I have a certificate of consent to self-insure, or a certificate of Workers'Compensation Insurance,or,a certified ZONING ENG.SITE NO. copy thereof(Sec,3800,Lab.C.). Policy No. - Company' O ❑ Certified copy is herebyfurn lied. FIRE SPRINK ENERGY T-24 Z Z ❑ 'Certified copy is filed with the city inspection division. F O Applicant MISC.- -REFER TO ORD. {Y C] N� Y ❑ NO try CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C. LU COMPENSATION INSURANCE. - PLG.CONTR. LIC.NO. PLG. QU 1 O •(This section neednot be completed if file permit is for one TOTAL Y N 'Y[:] N ::) Z Imndred•dollars(S100)or less.) _ - - _ U O I certify that in the performance of the work for which this per a t +r s - ` fi 4.r.�y s �' t n. FEE SUM�N'ARYn A A YB LL F mit is issued,I shall not employ any er n in an I r o us to OTVr :' t q MECHANICAL,PERMITx' F" FChF,EE 3'$A t x-„ „„y"gp'8., ,ag, Q W become subject to file Workers' s w o i , b ' 5"+' c e •' - y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } m NOTICE TO APPLICANT:If,after making tlds Certi fiwte of P,x- F.. Z_ emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions,of the.Labor Code, you must forthwith comply with FEE' C..1 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4,00 CONSTRUCTION LENDING AGENCY ' AIR HANDLING UNIT(OVER 10,I)MC.RM.) 6.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. - MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address - HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 'I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING ordinances and•state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives ins inspection this city es enter upon the BOILER-COMP(Over 100,000 BTU)SEE FE E SCH, MECHANICAL above-mentioned property Porins Poft ipurposes. (We) agree to'Save, indemnify and keep harmless the City of MISC.- REFER TO ORD. - - Ci�� ,judgments, costs and expenses which PERMIT ISSUANCE' 10.00 CONST.TAX Cyy in consequence of theC MECH.CONT. LIC.NO. MECH. ffiL TOTAL 41 A TOTAL, ig lure of Apphean/Contractor Date .. OFFICE COPY - '