12327 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
' BUILDING PR ECT IDENTIFICATION APPLICATION & PERMIT PERMIT NUMBER
BUILDING
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`G z J� _ S y0 1J, BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 12327
OWNEWs PLAN CHECK VALIDATION
OTY. ELECTRIC PERMIT FEE
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CONTRALTOfl'a _
nte��� / -�0 CJs OUTLETS 10.00/1.00
/L GCEG Uc N� ,f LIGHTING FIXTURES 10.00/1.00 0 Q
eoNTRACr1R's PPLIANCES-RESIDENTIAL 4.00
nooREss 'J
SA•��el/vdcb Fi�NE 6y - 16 PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN......
HECK FEE P.C.NO.
OR QQ
EN Oel
(7R. 'No. SIGNS TRANS. 3.00
ARCH.08 ENG. - $REDIAE CIRDUIT 5,00 PERMIT VALIDATION
ADDRESS
ZIP EMP.METER OR POLE INS. 20.00
AvvucaNrs ! MOTORS ` SEE FEE SCH.
ADORE ,
SERV( ANGE 20.00 / gi
W o O LICENSED CONTRACTORS DECLARATION ,VI
u w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and G. MECH.
G zi 2 ProfasoonI Code, - y (cense is In full for nJ c BLDG. ELELT. PL
Z O a- License la Lic.Number O ❑ EI ❑
9 w F G file Contractor
OWNER-BUILDER DECLARATION MOO BUILDING PERMIT
-o'"D MISC.- O pqp INFORMATION
E
;u N 1 hereby affirm,[hat I am exempt from the Contractor's License /O_ VALUATION SIFT.
r LL o al Law for the following reason.(Sec.7031.5,Businessand Professions - PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter,
Le Q 0 Improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO,
ELEC. QQ
i
O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
w$ he is licensed pursuant to the provisions of the Contractor's License EL "L
F z a Law(Chapter 9(Commencing with Section 7000).fDivision 3 of the
P i O Business and Professions Code)or that he is exempt therefrom.,,it OTY. PLUMBING PERMIT FEE
W I- the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i ;� by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
Of not more than five hundred dollars($500),):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC,GROUP RES.UNITS
their sole compensation,will do the work,and'the structure is not
o intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
tilxl F.2 Code:The Contractor's License Law does not apply to an owner of -
>n property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
fps, himself or through his own employees,provided that such improve-
�I/ ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 -
/ or improvement is sold within one year of completion,the owner-
F4. builder will have the burden ofproving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
RES IND CON PB OrNer
prove fors owner of sale.). INDUSTRIAL WASTE INTER. 30.00
❑licensed as owner of the property,he exclusively contracting with ❑ ❑ ❑ ❑ ❑
ad.Pcontractors to construct the project La 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law Joos not apply
to tr owner of h projects
who builds or improves Insed pursuant
and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts four's L pensee is with a comrucmAsl licensed pursuant m -
theContractor'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00 '
reason
Owner - Date WATER SYSTEM 5.00 ACC,-GATE ACC,FILE N0,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to sellff-irrrrrrn��y��ys(((i(((nyyye, ZONING ENG.SITE NO.
ar a certificate Workers'Compep- o ri
copy thereof(S c 3800,Lab.C.) a*,*� Jy r
Policy No. C npany �rR167601
Q ❑ Ce Ill opy ereby onusu C FIRE SPRINK ENERGY T-24
Z Z ❑ Cer(i cory� filed fit the city 'nspectian division. MISC.- REFER TO ORD.
APPlicanl Cr6. Y❑ N❑ Y ❑ N❑
W CER IFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.c.
LU > COMPENSATION INSURANCE PLG.CONTR. ❑c.NO. PLG.
CL 0 (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
D Z hundred dollars(S 100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued, I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California. BUILDING
Date.Applicant ALTER OR ADD TO MECH. 5.00
>_ N NOTICE TO APPLICANT: II',after making Ibis Certificate of Ex-
H ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
Provisions of the Labor Code, you must forthwith comply with FEE
f..) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST.HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec.
3097,CIv.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lenders Name
Lender's Address - HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRICd'NZ `
,:d! I certify that l have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
tlIER information is correct.I agree to comply with all city and county PLUMBING
ordinances and state laws relating to.building construction, and BOILER-COMPOH.Ror100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon-the BOILER-COMP IDV01100,000 BTU)SEE FEE SCH. MECHANICAL '
above-mentioned property for inspection put poxs.
(We - ee to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cuinn)gains( liabilities,judgments, costs Lou expenses which PERMIT ISSUANCE 10.00 CONST.TAX
y G way accrue against said City in consequence of the
g of is peemil. MECH.CONT: LIC.NO. MECH.
L A� TOTAL TOTAL
r' .aligna ureof ppicanf/Contra
lctor are
OFFICE COPY