1713 i
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
4 BUI LDI NG PROJECT IDENTIFIC APPLICATION $ PE T PE IT E ��
BUILDING
ADD E
&f 76-rao WW
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
O 's - - PLAN CHECK VALIDATION
" ME v CITY. ELECTRIC PERMIT FEE
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ACTORa
NAME UTLETS-SWITCHES-RECEP 5.00/1.00
LIC.NO. LIGHTING FIXTURES 5.00/1.00
ADDRESS APPLIANCES.. PPLIANCES-RESIDENTIAL 4.00
PRONE PANELS 5.00 DATE OF APPLICATION
ARCHITECT Pt. HECK FEE P.0 NO.
OR SIGNS 6.00
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
A
ZIP EMP.METER OR POLE INS. ' 15.00
APPLICANT'S
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00
ax
' 02 LICENSED CONTRACTORS DECLARATION OFT
a aw.+U I hereby affirm that I am licensed under provisions of Chapter 9 1� ISSUANCE DATE
hz w (commencing with Section 70001 of Division 3 of the Business and - BLDG. LECT. PLG. MECH.
H wo i Professions Code,and my license is in full farce and effect. El El
❑
Zo 0 A G License Class Lie.Number
H m H j 1982 Date Contractor 19
A, ,: -+ I BUILDING PERMIT
¢ a OWNER-BUILDER DECLARATION 1
o a u INFORMATION
w0. m 1 hereby affirm that I am exempt from the Contractor's License MISC.- _ REFER TO ORD VALUATION S/FT.
H aL 0 a Law for the followinis eason.(Sec.7031.5,Businessand Professions pERMIT.ISSUANCE' 6.00
5;v,� Code:Anycity orcounly which requires a permit to construct,alter, N
Be R Q O improve,demolish,or repair any structure,prior to its issuance,also ELED.CONTR. LIC NO. ELEC. /y
wO u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO -
m he is licensed pursuant to the provisions of the Contractor's License - n
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