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C 8418APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LOING PROJECT I DENTIFICA� A. Els, /O ADDRESS � � / � /� / Olo �-V�V APPLICATION & PERF BUILDING -ELECTRICAL -PLUMBING -MECHANICAL PERMI NUMBER � 418 DWNER's No M A AJ e' NAME Tb UJ N NOM E5 C 0 PR -r 0 PHONE CITY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION ��stlYwlll��_rrrr CONTRACTORS �/f� .1,, NAME sir= iQRPr QGr /Y5 -t �fyt.x UTLETS-SWITCHES -RECEP 10.00/1.00 LIC. NO. DATE OF APPLICATION LIGHTING FIXTURES 10.00/1.00 fi- - CONTRACTOR'S $ApO�S ��f /' .QI 100 v3207.oNE /7,/0 PPLIANCES-RESIDENTIAL 4.00 PANELS 10.00 ogcRlTl:cT ENGINEER LIC. ND. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO, SIGNS TRANS. 3.00 ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP. METER OR POLE INS. 20.00 APPLICANT'a ADDRESS MOTORS SEE FEE SCH. SERV. CHANGE 20.00 , LICENSED CONTRACTORS DECLARATION POLE TEMP. POLE 30.00 th I hereby affirm Thal I am licensed under provisions of Chapter 9 (commencing with Section 700e)i of Division 3 of the Business and Professions C e„gp-y license is in full r an6eiQ License C u /.. Lic. Number J 7 ISSUANCE DATE BLDG. ELECT. PLG. MECH. ❑ ❑ ate Contractor QQ OWNER -BUILDER DECLARA If Ct I hereby affirm that I am exempt from the Contractor's License Law for the following mason. (Sec. 7031,5. Business and Professions Code: Any city or county which requires permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Low (Chapter 9(commencingwith Section 7000) of Division 3 ofthe Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant (oacivil penally of not more than five hundred dollars ISSUE).): - BUILDING PERMIT ANrrQfk ATION $/FT. 11 q rr -b y 2ff100 MISC. - REFER TO ORD PERMIT ISSUANCELUATION 10.00 ELEC. CONTR. LIC. NO. ELEC. TOTAL PERMIT TO /-57 1/P W�}LL OTY. PLUMBING PERMIT FEE ALTER -DRAIN -WATER (EA.) 5.00 STORIES TYPE CONSTR. ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the sl ructure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS intended or offered for sale (See. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mentsarenotintendedorofferedforsale. If, however, the building DRAINS -FLOOR, ROOF, AREA, COND. 5.00 FIXTURES - PER TRAP 5.00 GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00 SD. FT. FLOOR AREA TOTAL ACREAGE or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or im prove 1. as ownerose of sale.). ❑ L as owner of the properly, he exclusively contracting with licensed contractors to construct the project La 7044, Business and Professions Code: The Contractors License Law does not apply to ancontracts owner of property who builds or improves rased u and who for such projects with a contmetortsl licensed pursuant m the Contractor's the Contractor's License Law. ❑ lam exempt under Sec.., B.&P.C. for this reason GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING USE RES I❑ ❑N PB ❑ Other❑ 1:1 INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS -OVER 5 (EA.) 1.00 ASSESSORSPARCEL NO. SEWER -SANITARY -STORM EA. 200h/10.00 TRACT NO, PARCEL NO. WATER HEATER W/VENT 6.00 Owner Dale WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 - I hereby affirm that I have a certificate of consent to sell -insure, ZONING ENG. SITE NO. or a cerlif ate of Workers' pensalion Insurance, or a certified 'copy Ih�/,�yL!�,F (J/1 Policy No.�7� �ompa �.[F� ❑ Certified copy is hereby furnished. ❑ Cerl i9 g k ys _ fjled svjfl,al)y ly i sp <Imn Applicant C ��iij(�Zr/�'• ] /tr ��_� FIRE SPRINK Y � N� ENERGY T-24 Y ❑ NJ_ REFER TO ORD. PERMIT ISSUANCE 10.00 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCEPLG. (This section need not be completed if the permit is for one FLOOD ZONE Y El a. L.U.C. Y EDN� CONTR. LIC. NO. PLG. TOTAL hundred dollars (S 100) or leu.) I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so OTY MECHANICAL PERMIT FEE FEE SUMMARY Inn become subject to the Workers' Compensation Laws of California. Dale Applicant NOTICE TO APPLICANT: If, after making this Certificate of Ex. BUILDING �� ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (TO 10MC.F.NL) 4.00 AIR HANDLING UNIT (OVER 10A00C.F.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY I hereby affirm that [here is a constructionisg agency for the performance of the work for which This permitmit is issued (Sec. 3097, ). Lender's NNaame EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 ' s Lender's Address - HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and authorize herebhereby authorize representatives of this city es enter upon the y property for inspectionf this purposes. VENTILATION FAN (SINGLE) 4.00 BOILER-COMP13 H. P, or 100,000 B.T.U.) 6.00 PLUMBING BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL (We) agree tD save, indemnify and keep harmleu the Cily of nst liabilities, judgments, costs and expenses which emaynay accruesaid City in consequen a of hepermi . MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT. LIC. NO. MECH. TOTALTOTAL plicant/Can tractor ate ' OFFICE COPY