18307 APPLICANT TO FILL IN INFORMATION INITHIN.RED LINES - USE'BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION - PERMIT NUMBER
BUILDING - APPLICATION & PERMIT
ADDRESS UILDING -ELECTRICAL-PLUMBING-MEMECHANICAL - All 18.3
8
.30?
PLAN CHECK VALIDATION
" Ir; TY. ELECTRIC PERMITr� FEE
.; PHON a1. /o
CONTRACTOR'S
- NAM UTLETS-SWITCHES-RECEP 10.00/ .0 7
a:lc.No. 7 LIGHTING.FIXTURES �' 0.00/1,0
CON RACTOR'S _
ADDRESS _" 4.00
WW1& HON PANELS . 10.00 DATE OF APPLICATION
ARCHITECPLAN CHECK FEE P.C.N0.
OR - ANELS (OVER 200 AMP) S 20.00
ENGINEER
_IGNS TRANS. 3.00
ARCH.OR 911N Aa
ADDRESS ENG.
PECIAL CIRCUIT 5.00 PERMIT VALIDATION -
' ZIP EMP. METER OR POLE INS. - 20.00 •'
APPLICANT S,
ADDRESS MOTORS SEE FEE SCH.
' SERVICE CHANGE 20.00
'woo •LICENSED CONTRACTORS DECLARATION
S'o w I hereby affirm that I am licensed under provisions of Chapter 9 - ISSUANCE DATE
Fyi Professions Codlt and rvy II e000is irn Dullstore',uf theBusiness and BLDG. CT. LG. CH.
Zo i H.o Licen'corese Class Lic.Number - e 71 _r Err
-
r w r A. Date
�"7 Contracmr_ 1989
¢ rt
at ¢ OWNER-BUILDER DECLARATION Iv BUILDING PERMIT ,
°A °=_ MISC.- D INFORMATION
I hereby affirm that 1 am exempt from Contractor's License
w LL y..-
aa u o s, Law for the following reason.(Sec 7031.5,Business and Professions PERMIT ISSUANCE 00 ^ VALUATION $/FT.
Code:Any city or county which requires a permitto construct,alter,
¢ ¢Q O improve,demolish,or repair any structure,prior to its issuance;also BLED,CONTR. _ - LIC.NO. ECEC.
a.•wO ¢ requires the applicant for such permit to file a signed statement that TOTAL7 P gMIT TO
m" he is licensed pursuant to the provisions of the Contractor's License - �"/O
rZQLaw(Chapter 9(commencingwith Section7000)of Divlslon3 ofihe
4 0 Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT' EE 4 k
SEI-o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TVP C NSTR.
w 3 m ' by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars($500).) - ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ I,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,'AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
properly who builds or improves thereon,and who does such work - FIXTURES-PER TRAP 5.00 SO.FT.FLOOR ARA tOTALACREAGE
himself re of intended
own employees,provided timethe
improve-
or nts improvement is sold or within tvd une or year e.of c however,l [the o nee- GAS-EA.SYSTEM'-1 INC.4OUTLETS 6.00
or improvement have
t is sold within poo;unar of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did.hot build or im- BUILDINGUSE
prove forpurpose of sale.). _ RES ' IND CON PS Other
❑.-I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. . ' 6.00 ASSESSORS PARCEL N0.
and Professions Code;The Contractors License Law does not apply-
` 1 to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
Contract, 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 Sea ,B.&P.C.for this WATER HEATER W/VENT 6.00
I reason '
Owner Date WATER SYSTEM '5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
hereby affirm that 1-have a certificate'of consent to sell'-insure,.
or a certificate of Workers'Compensation Insurance,ora certified ZONING ENG.SITE NO.
coPY t re 6 •Lab.CJ i, - - ,
Poli o t Jany�� ,
�I ertilie 'op eby r I ed. FIRE SPRINK ENERGY T-24
Z.Z cl,
'led
th the city inspection.disision, MISC.- REFER TO ORD.
O APPlicant Y ❑ N❑ Y ❑ IN
� N CERTIFICATE OF EXEMPTION FROM WORKERS" PERMIT ISSUANCE 10.0011 y FLOOD ZONE A.L.u.c.
LU > COMPENSATION INSURANCE . PLG.CONTR. LIC.NO.
PLG.
1 (This dollars need not be completed if the '+ TOTAL 3�o w Y❑ N❑ Y ❑ N❑
p permit is for one e
i U O handled dollars($100)or less) � - � -
1 certify that in the performanec'of the work for which this per- QTY MECHANICAL PERMIT FEE - FEE SUMMARY
LL.U mit is issued,I shall not employ any person in any manner so as to
O IL become subject to the Workers'Compensation Laws of California:
Date - Applicant' - - BUILDING
} faro NOTICE'TO'APPLICANT: If,alter making this Certificate of Ex ALTER OR ADD TO MECH. - 5.00
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
V such provisions or this permit shall be,deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
,CONSTRUCTIONLENDINC AGENCY AIR HANDLING UNIT IO,000QF.M.) 6.00 SEISMIC FEE 'r / _
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. ICROFILM
3097,Cie C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 - 1
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 41'/O
Lender's Address - 'ELECTRIC 7
I certify that I have lead this application and state that the above VENTILATION FAN (SINGLE) 4.00 -
information is correct9 agree to comply with all city and County 801LER-COMP13 H.P,or 100,000 B.T.U.) 6.00 PLUMBING 30 OO
ordinances and`.state laws relating to building construction, and
hereby authorize representative this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. ��
above-mentioned property for' 'tion purposes. - MECHANICAL
- (We�agree to a e, into nl and keep harmless the City of MISC.'- REFER TO ORD.
ape r aga_i t biline ju grients, costs and expenses which PERMIT ISSUANCE 'I' 10.00
may i any ccrue g st said City in consequence of the 7
' m it Oft rmit. MECH.CONT. LIC.NO. MECH
-g TOTAL/W. TOTAL 9� 7
Signature of Applicant(Conlractor .. Date -
OFFICE COPY