29775APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
ra•nv eF rnocomOvn BUILDING - ELECTRICAL
BUILDING DIVISION APPLICATIONIPERMIT
106131%
7E
29775
OFFICE
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❑ Consultant Fee Paid by Applicant (Initial)
BLDq HL PLUMB MECCH
Il1sLLT\
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm mat 1 ant Baaxd made, p tumors of Chnpmf 9 (eommenehtg
with Sec um l(p0)otDivisi Jofthe Buaimsswd o 9yCyg�a�gp�my licenu is
in full dose and eReet. s {, S7
Licenx Lic. M
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Dace Contmcto
ARCHITECTS DECLARATION
I unmund my plans shall lx used as public records
de
QTY. ELECTRIC PERMIT FEE
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7th
JOB DESCRIPTION
RESIDENTIAL:
❑SFDWL El KITCHEN REMODEL
❑ADDITION ❑PLUMBING RE -PIPE, I,
El MULTI -UNIT CSTRUCTURAL
MODIFICATION
PERMIT ISSUANCE
APPLIANCES- RESIDENTIAL
PANELS
Z`�'M
ry t�i
tiG
3 C L U
O F
AWAWS
UPT0200AMPS
❑INTERIOR ❑CHIMNEY REPAIR
IMPROVEMENT
[I BATH 0.EM0 PAIR D OLI N
❑ 0TH
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby offimt that 1 am exempt from the Contractor's License Law for me
following reason. (Section 7031.5. Business and Profeuome, Code: Any city or county
which requires a permit to construct, altar, improve, demolish, or repair any structure
prior to to issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant m the provisions of the Contmcme, License Law (chapter 9
201-1000AMPS Is.
OVER IOOO AMPS
SIGNS ELECTRICAL
SPECIALCIRCUIT/MISC.
TEMP. METER OR POLE INST.
COMMERCIAL:
Cp0q
(commencing with Section V000)of Division J afore Business area Profusions Cade) or
o W
O mrd
Z6
that he is exempt therefrom adnthe breis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
nor more Nan fee hundred do]].DS0dL
01, as owner of the property, in my employees with wages as their sole compensation,
will do the work. and the shpcture is not intended or offered for sale(See 7]
C NEW BLDG/ADDITION C DEMOLITION
❑TENANT ❑FOODSERVICE
IMPROVEMENT
(]OTHER
POW ER DEVICES
SWIMMING POOL ELECTRIC 10
a1'•' to
a• 3
,Business
and Professions Code: The Convector's License Law arcs not apply to an owner of
property who builds or improves thereon, and who docs such work himself or through
his own employees, provided that such improvements me, nor intended or offend fol
aide. If, however. the building or improvement is sold within oneyear ofcompletinn,Na
ovemer -builder wil l have the burden of proving that he did not build or i reprove for put-
OUTLETS- SWITCHES -FI%TURES
NEW RESIDE Ud. ELECTR SQ FT.
1r
t�SU, PI"FL�R v E
tl LL��
J VS Q. FT
po
poor of s..a wird licensed rontroa. m
❑1, asownerof the progeny,amexdusicely
APR 19 1996
TOTAL:
and Professions Tho
onsvua, hewd project (Sec. Profession,
ttnx Lawdrc not to an owner of ds or improver ther:uu's rid
plymm
Q7y, PLUMBING PERMIT FEE
or such ithaofpropertywhobuddsort rollCmus,emf
who contracts far such projects wird a contmcror(s) licensed pursuant tome Commcmr's
PERMIT ISSUANCE
License law.
❑ Iamexemptumder Sec. .B&PCforthisoawm
DG. I NSP//ECTIOaaNDDEPA
TMENT
ALTER - DRAIN & VENT - WATER (12A)
Owner Data
AIT}��QF CVVVPM'MNO
LP
WORKER'S COMPENSATION DECLARATION
BACK FLOW PROTECT. DEVICE
I hereby tiff under penalty of Fe jury one of the following declarations:
DRAINS - FLOOR. ROUP. AREA, GOND.
C l have and will maintain a Certificam of Consenuo self-insum far Workers Compen-
sation, as provided for by Section 37ID of the labor Costa, for the performance of are
STORIES
TYPE CONSTRUCTION
FIXTURES - 1117R TRAP
for which this permit is issued,
ave and will maintain Workers Compevuion Imtuenee, as requiuA by Secuan
700ufthe labor Code.fm Ne performance ofthe work for which this permit is issued.
My Wo r 'dip en. nhom 'e carrier and Policyyjj� &/�7
Policy No.:GY_
Carries - L T��Y
GAS - EA. SYSTEM -I INC. 4 OUTLETS
OCC, GROUP
APN
GAS - EA. SYSTEMAVER4(EA)
CERTIFICATED •(EMPIION FROM WORKERS'
COMPENSATION INSURANCE I
(This section need ria becompleted ifthe Front is foram hundred dollen (5100)
or less.)
GREASEIINDUSTRL WASTE INTERCEPTOR
BUILDING DIVISION FEES
GREASE TRAP
PLANCHECK FEE
SEWER - SANITARY -STORM EA. 200 PT.
I certify that in thcperfonoanceofthe work for which this permit is issued.)shall
not employ any person in any manner so as ro becatne subject ro rhe Workers' Compen-
ENERGY FEE
zZ
2
ration Lows of California. Date
Applicant -
WATER HEATER W/VENT/ELECR
GRADING FEE
NOTICE'IO APPLICAT: If, after making this Certificate of Exemption, you should
become subject m the Waimea Co ama smimprolls,mal of the labor Code, you most
forthwith comply with such provisions or this permit shall he deemed revoked.
CONSTRUCTION LENDING
herebyaffirmthat NemissedSce..3097,lending agency fmNepdomanttof
the sent, for which this permit is issued (Sec. IIM11, Civ. CJ
WATER SYSTEM/TREATING
WATER SERVICE
y
a
Q
(J0
(~•'
SOILS FEE
PAID
Date Receipt g
NEW RESIDENTIAL PLMP. SQ. PT.
Q U
(A
Lender's Name
Lender's Address
1 sonify f have read this application and stem thm the have information is
TOTAL:
TOTAL:
BUILDING FIiC .0
fA
U�
o c
comect.Iagree to comply with all cltyvd countyordinanceseaand smta entaruatingu
buildingconswcnian, and hereby amthodureprtxnutives ofthi.ciry manner upon the
Q7y, MECHANICAL PERMIT FEE
SEISMIC FEE
above-menuoned property for inspection purposes.
(We) agree 10 save, indemnify end keep h:umleas the City of Color.. against
PERMI'FISSUANCE
ELECTRIC FEE
ALTERORADDTOMECH.
PLUMBING FEE
Imbili6es,jupegmems, cost and expemxswhicIt they' my way recom against said City
in consequents of the granting elchis permit
AIR HANDLING UNIT (TO I0,000 CFM)
MECHANICAL FEE
APPLICANTI ERjTANDS ND WI ,C PLY 'ITH ALL NON -POINT
II ,�
AIR HANDLING UNI 'I'(OVER 10,000 CFM)
CONSTRUCIIONTAX
Sig wee ofApplicvVConvac • Date
HAZAft S MATERIALS DISCLOSURE
EXHAUST HOOD(W/DUCT)
HOUSING MITIGATION FEE
HEATING UNIT (W 100.000 RTU)
WII the aPPIibm. tum building occupant sore., handle houdous material
as defined by the Cuperpsl. Municipal Code. Chapter 9.12, and the Health and Safety
HEATING UNIT (OVER [pound BTU)
Cade, Section 25532(a) t
.
❑Yo .L3N.
Will the applicant or future building occupant use equipment or devices which
,.it para dons air contaminants as defined by the Bay A. Air Quality Management
Dimoct'
[3 Yes CNu
PAID
Data Receipt k
VENTILATION FAN (SINGLE RESID)
BOILER -COMP DHP OR 100.000 BTU)
TOTAL:
BOILER- COMP (OVER 100.000 BTU)
AIR CONDITIONER
I have read the hamrdous materials requirements under Chapter 6.95 of the Cali-
ISSUANCE DATE
NEW RESIDENTIAL MECH.
forms Health & Safety Code. Sections 25505, 25533 and 25534.1 uttdentand that if rise
building does not currently have o about, that it is my responsibility to notify the occupant
of the requirements whiclt must be met prior to issmnce oft Cri ilic ur of Occupancy.
ISSUED BY.
Owner or authoriuA but Dam
TOTAL]
OFFICE