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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PENONLY
- T BU I LDING PROJECT I DENTIF[CATION PERMIT` uM
BUILDING APPLICATION & PERMIT 9 4
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s"' C//�Ct(yD/, QLl�jlY4r Rd/ C��f/ BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S / PLAN CHECK VALIDATI N
NAME
Gl/i/l/Om �.�przc� r7- 1739CONTd
OTY. ELECTRIC PERMIT FEE
PHONE �p
c70Rs
NAME J UTLETS-SWITCHES-RECEP 5.00/1.00 aE
NAME
UC,NO 0 LIGHTING FIXTURES 5.00/1.00
CONTRACTORS IJ5 JAPPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE ffi PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS 6.00 PLAN CHECK FEE P.C.N0.
OR
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ADDRRESS END, SPECIAL CIRCUIT 6,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 15.00 -
APPLICANT S MOTORS SEE FEE SCH.
ADDRESS
.: SERVICE CHANGE 10.00
0000 LICENSED CONTRACTORS DECLARATION PAIn
¢U U 1 hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
N¢h (commencing with Section 7000)of Division 3 Of the Business and gLOG. ELECT. PLG. - MECH.
F m z Professions Code,and my license is in full form and effect. ElEl El i m W License Class Lic.Number
Date Contractor -
< y F J (rx� BUILDING PERMIT
Q tc w u OWNER-BUILDER DECLARATION - INFORMATION
oP. MISC.- REFER OORD
X 3 LL N 1 hereby affirm that I am exempt from the Contractor's License VALUATION S/FT.
uoa Law for the following reason (Sec.7031.5,Biomessand Professions PERMIT ISSUANCE 6.00
E Code:Any city.,county which requires a permit to construct,alter.
20 improve,demolish,or repair any Shuetu e,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
a K e M requires the applicant for Such permit to file a signed statement that TOTAL
xx$u he is licensed pursuant to the provisions of the Contractor's License
r z i Law(Chapter 9(commencing with Section 7000)of Division 3 of the
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ r D the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
yim by any applicant for a permit subjects the applicant Ica civil penalty ALTER-DRAIN -WATER (EA.) 4.00
of not mare than five hundred dollars(S5000.):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,GOND. 4.00
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 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-I I NC.4 OUTLETS 4.00
mems are not intended or offered for sale.If,however,the building
or improvement is sold within one year of completion,rhe owner. GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
builder will have the burden of proving that he did not build or int- RES IND CON PB Omar
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00
❑ 1,as owner of the property,am ekciosively contracting with El ❑ ❑ 1:1 El
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 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 contractor(S)licensed pursuant to
the Contractor's License Law. 11 SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO, PARCEL NO.
ran❑ I am exempt under Sec. ,B. C.for this WATER HEATER W/VENT 4.00
son y
Date WATER SYSTEM 4.00 ACC.DATE ^ACC.FILE NO.
WORKERS'COMPENSATIO DE LA RATION WATER TREATING EQUIP. 4.00 r
'I hereby affirm that I have a certificate ofemsent to sell-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3500,Lab.CJ.
Policy No. Company -
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is Filed with the City inspection division. MISC.- REFER TO ORD.
Q Applicant - -Y F] N❑ V ❑ No
= w PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
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