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3710APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENTIFIC - APPLICATION-& PINT BUILDING - ELECTRICAL- PLUMBING - MECHANIC DTV. ELECTRIC PERMIT FEE PERMIT NUMBER 3 % `� .O I I PLAN CHECK VALIDATION i BUILDING . ADDRESSSl L, F'• E. O N R'S NAME MM L �� NANT ACTORS I / Llc. No. UTLETS-SWITCHES-RECEP 5.00/1.00 LIGHTI NG FI XTU RES 5.00/1.00 CONTRACTOR S ADOR u 74'7_/ PPLIANCES- RESIDENTIAL 4.00 PANELS 5.00 Mp4gqfig,/� HONE GATE( APPLICATION AR HI ° OR ENGINEER LIC. No. SIGNS B.QQ PLAN CHECK FEE P.C. NO, ' SIGNS TRANS. 3.00 ADDRESS ENG. - SPECIAL CIRCUIT 5.0Q PERMIT VALIDATION EMP. METER OR POLE INS. 15.00 ZIP pp.1101 1 \UN G u 3 ISSU' T 1' APR ICANrs EBB LfE IsSEE FEE SCH. SERVICE CHANGE 10.00 LICENSED CONTRAC ORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (Commencing vv Section 1000) of Division , of III ��yyysmess and Professions Co caseis in full f ens Class Ln Number ELEC . ❑ PLG. MECH. ❑ : ❑ Da Dale '� Cntractoro BUILDING PERMIT INFORMATION WNF.R-BUILDER DECLARA I . ' 1 hereby affirm that I am exempt from the Cont ctor's License. Law for the following reason. (Sec. 7031.5. Business and Professiops Code'. Any city or county which requires a permit to construct alter. ,. improve, demolish, or repair any structure, prior to its issuance, also MISC. - REFER TO ORD VALUATION // 4 $/FT. ' PERMIT ISSUANCE 6.00 ELEC. C LIC. NO. ELEC. requires the applicant for such permit to file a signed statement that he is licensed pursuant en the provisions of the )ofDivision License43S Law (Chapter 9 (commencing with flection is exempt thu et 3 of the .Business and Professions Code) or that he is exempt there Gum and TOTAL PERMIT TO OTV. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section by any applicant for apenre subjects the 0).). amfnacivilpenalty malty of not more than five hundred dollars (5500). P. ALTER-DRAIN-WATER(EA.)4.06 ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 2.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA,COND. 4.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner. of property who builds or improves thereon, and who does such work FIXTURES - PER TRAP 4.00 $6 FT. FLOOR AREA TOTAL ACREAGE himself or through hisown employees, provided that such improve- mentsare not intended oroffered for sale. If, however, the building GAS - EA. SYSTEM -1 INC.4 OUTLETS 4.00 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 for purpose of soled' ❑ as owner of the property, exclusively contracting with GAS - EA. SYSTEM -OVER 4 (EA.) 1.QQ BUILDING USE IND CON PB Other 0 11 O 0 INDUSTRIALWASTE INTER. 20.00 d licensed contractors to eCm,uclthe project (See. 7044, Business he and Professions Code: The Contractor's License Law deo . at apply to owner of property who builds who improves thereon, and who LAWN SPRINKLERS -1 INC5 V.B. 5.00 LAWN SPRINKLERS -OVER 5 IEA.1 1.00 aSSE550RS PARCEL N0. tr with a contractor)s) licensed pursuant to tr contracts for such License the Contractor's License Luw. SEWER -SANITARY -STORM EA, 200ft/8.00 ACT NO. PARCEL NO. ❑ I am exempt under Sec.-, BAP.C. fnr thisWATER HEATER W/VENT 4.00 reason Dace Owner WATER -SYSTEM 4.00 ACC. DATE ACC. FILE NO, WATER TREATING EQUIP. 4.00 WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of co seN {p -i nsurc. or a certificate of Workeri Com tion Ins" nee, rtifi¢d ZONING ENG. SITE NO. copy there 800, Lab .C.l Policy No. Company - FIRE SPRINK Y 0 N ENERGY T-24 Y [3 NE] ❑ tified o arcby ft nts Certified cop it it h th city inspection division. Applicant "7a`CERTIFICATE MISC. - REFER TO ORD. VVI OF EXEI PTION FROM WORKERS' PE T ISSUANCE 6.00 - 'OD FLOOD ZONE A.L.u.C. PLG.CONTR. ITOTAL119,0V PLG. COMPENSATION INSURANCE (This section need not be completed if the permit is for one Y 0 NE] I Y C] NC] OTY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars (S 100) or less.) I certify that in the performance of the work for which this per. mil is issued, I Shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. Dale Applicant NOTICE TO APPLICANT: If, after making this Certificate of lix- BUILDING SG ALTER OR ADD TO MECH. 4.00 APPLIANCE 4.00 PLAN CHECK 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. FEE AIR HANDLING UNIT (TO 10p000-F.M.) 3.00 AIR HANDLING UNIT (OVER 10,000C.F.M.) 5.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00 the performance of the work for which this -permit is issued (Sec. 3097, Civ.C.). HEATING UNIT (TO 100,000 B.T.U.) 4.001MICROFILM HEATING UNIT (O VER 100,000 B.T.U-)7.50 ELECTRIC -� Lender's Name Lender's Address I certify that 1 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 VENTILATION FAN (SINGLE) 3.00 PLUMBING 1 et za BOILER-COMPI3 H.P. Or 100,000 B.T.U.) 4.00 BOILER -COMP (Over 100,000 BTUI SEE FEE SCH. MECHANICAL hereby amhoriLe representatives of this city to enter upon the tinned property for inspection purposes. abni.'-ng MISC. - REFER TO ORD. ree ts e,indemnify and keep harmless the City of Cuagainst abilitieS,judgments, costs and expenses whichpERM1T way cer against said City in consequence of thegrathis pc i • ISSUANCE - 3.00may CH. CONT. LIC. NO. MECH. TOTAL TOTAL Sig PIRCant ontrac Dn Inure OFFICE COPY