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4232as a Z. 00 QVU Z i ¢ 9 2 O A P L L W s 6 Q w V w 3 A u Hu0¢ W¢oa AOru La D La HZQ sio ¢ r $ a 3 .- j O Z_z y CC T CL o v0 LL U Oa } N OF APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY I;UG.DING PROJECT IDENTIFICATION APPLICATION &PERMIT BUILDING - ELECTRICAL- PLUMBING -MECHANICAL PERMIT NUMBER n " T 232 VALIDATI N .OILDING AODRESo H �f C.11i NAME 44 CITY. ELECTRIC PERMIT FEE RACTOR '. UTLETS- SWITCHES -RECEP 5.00/1.00 LIGHTING FIXTURES 5.00/1.00 LIC. NO. r, rRA R's •- -ss PPLIANCES- RESIDENTIAL 4.00 PANELS 5.00 Ptetligq I¢ DATE OF APPLICATION AR ECT OR ENGINEER ' uc.No. SIGNS 6.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS.: 3.00 ARCH. OR ENG, ADDRESS SPECIAL CIRCUIT 5.00 PERMIT VALIDATION TEMP.METER OR POLE INS. 15.00 nv 01,� ADDRESS - AOOREss MOTORS SEE FEE SCH. SERVICE CHANGE 10.00LICENSED JEDAIE CONTRACTORS DECLARATION 1 hereby affirm that 1 am licensed under provisions of Chapter 93 ISSUA (commencing with Section 7000) of Division 3 of the Buss ess and Professions Clse is in full t •c . License Class Lic. Nwnber L G. ELECT. PLG. MECH. ❑ ❑ Ualc Contractor , BUILDINGP IT " OWNER -BUILDER DECLARATION I herebyaffirm that I am exempt from the Contractor's License a P following reasom(Sec.7iresa emit to codProfessions Law for Any Code: Any city or county which requirese permit mconsua c alter, improve, demolish, or repair any structure, prior to its issuance, also INFORM TION MISC. - REFER TO ORD VALUATION PERMIT ISSUANCE _ 6.00 ELE ON C. NO. ELEC. t Snell Permit ns file a Signed statement that heQ W(CS IIID dp pursuant he is licensed Pursuant en the with provisions of the nl ivisios License D ivision3 and Law (Chapter 9(commencingwith Section is exempt Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 TOTAL P RM T TO /f , i OTV. PLUMBING PERMIT FEE STORIESv TYPE CONSTR. by any applicant for apermil subjects the applicant to a civil penaltyALTER-DRAIN&VENT-WATER(EA.)4.00 of not more than five hundned dollars (S50OLL C1 1. 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 OCCGRouP . RES. UNITS DRAINS -FLOOR, ROOF, AREA, GOND. 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 50. FT. FLOOR AREA TOTAL ACREAGE himself or through his own employees, provided that such improve •nts are not intended or offered for sale. If, however- the building GAS -EA. SYSTEM- 1 INCA OUTLETS 4.00 inpravemem is sold within one year of completion, the owner der will have the burden of proving that Be did not build or im prove for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM -OVER 4 (EA.) 1.00 BUILDING USE IND .CON PB other ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 20.00 LAWN SPRINKLERS - 1 INC 5 V.B. 5.00 licensed contractors to construct the project (Sec. 704.4, Business 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 - OVER 5 (EA.) 1.00 ' contracts for such projects with a commetor(s) licensed pursuant to the Contractors License Law, SEWER -SANITARY -STORM EA. 200ft/8.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,B.&P.C. for this WATER HEATER W/VENT 4.00 son Dam Owner WATER SYSTEM 4:00 ACC. DATE / ACC. FILE NO. WATER TREATING EQUIP. ' 4.00 WORKERS'COMPENSATION DECLARATION 1 hereby affirm that 1 have a certificate of co en`to -insure, or a certificate of Workers' Co sation Iii ¢e, or c tificd ZONING ENG. SITE NO. copy that • 1 cQ A00, Lab.C. Polic]�No. Company _ FIRE SPRINK ENERGY T-24 OP Cerh Ie co Is hereb I f nish P -Certified c p is fi with to city inspection division. AP v❑ N Y❑. NC]Plicant MISC.- REFER TO ORD. PERMIT ISSUANCE 6.00- FLOOD zorvE AL. u.c. • CIiRTIF AT . ' E 'S TJONFROM WORKF,RS' PLG. CONTR. LIC. No.PLG. TOTAL COMPENSATI DNINSURANCE (This section need not be completed if the permit is for one Y ❑ N❑ Y ❑ N❑ MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars (S 100) or less.) I certify that in the performance of the work for which this per -QTY. mit is issued, I shall not employ any person in any manner so as to BUILDING 7,C �,L� become subject to the Workers' Compensation Laws of California. Date -Applicant NOTICE TO APPLICANT: If, after making this Certificate of Ex. sorption. you should become subject to the Workers' Compensation ALTER OR ADD TO MECH. 4.00 APPLIANCE 4.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with such provisions or this pemlit shall be deemed revoked. CONSTRUCTION LENDING APENCY FEE AIR HANDLING UNIT (TO 10000C.F.M.) 3.00 AIR HANDLING UNIT (OVER 10=C.EM.)5.00 SEISMIC FEE �f Fw EXHAUST HOOD (WITH DUCT) 2.00 MICROFILM 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Cie.CJ. HEATING UNIT (TO 100,000 B.T.U.) 4.00 HEATI NGUNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC Lender's Name Lender's Address I Certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ances and state laws relating to building construction, and VENTI LATION FAN ISINGLE) 3.00 PLUMBING BOILER- COMP H.P. or 100,000 B.T.U.) 4.00 BOILER -COMP IOver 100pGO BTU) SEE FEE SCH. MECHANICAL ty authorize representatives of this city Io enter upon the •-mentioned property for inspection purposas. MISC. - REFER TO ORD. CONST. TAX e agree to save, 'ndemnify and keep harmless the City of C erti against liabil ies, judgments, costs and expenses which y in y way acct ag st said City in con Yuen of the g ming this permit. pERMIT ISSUANCE 3.00 MECH. CONT. LIC. NO. MECH. 0TAL TOTAL t Sl ature A plicanl/ ant actor ate OFFICE COPY