Loading...
12915APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY BU LDING PROJECT I DENTI FICATI ON APPLICATION & PERMIT PERMIT NUMBER 12915 BUILDING ADDRESS 7�/ �- NAME OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION G: ✓� �T• r GJ PHONE , CONTRACTOR'S NAME UTLETS--SWITCHES-RECEP 10.00/1.00 LION LIGHTING FIXTURES 10.00/1.00 DATE OF APPLICATION CONTRACTORS 'Oy �� I ADORESa PHON �„i1���C'L� PPLIANCES-RESIDENTIAL 4.00 PANELS 10.00 AflcHITecT- OR ENGINEER LIC. No. PANELS(OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH. OR ENG. ADDRESS ZIP SPECIAL CIRCUIT SAO PERMIT VALIDATION TEMP. METER OR POLE INS. 20.00 APPLICANT s ADDRESS MOTORS FEE SCH. SERVICE CHANGE �' 20.00 LICENSED CONTRACTORS DECLARATION 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 Professions Code anJ ylicense is in full force nd f cf,'y 4 Lia Number License Cla..ss��r d -. BLDG. ❑ ELECT. PLG. MECH. ❑ , ❑ �P s DateL� Contractor �L ` OWNER -BUIL DE LAR I 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Sec. 7031.5, Businessand Professions Code Any city or county which requires a permit to constmeL alter, Improve, demolish, Or repair any structure, prior to Its Issuance also requires the apphcaN for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(commencingwith Section 7000) of Division 3 ofthe Business and Professions Code) Dr that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 BUILDING PERMIT INFORMATION MISC. - REFER TO ORD vALUATtory S/FT. PERMIT ISSUANCE 10.00 Q ELEC. CONTR, LIC. NO. ELEC. TOTAL 3 PERMIT TO -7_Z/LY �Ler-1, OTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ALTER-DRAIN&VENT-WATER IEA.) 5.00 ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS - DRAINS -FLOOR, ROOF, AREA, COND. 5.00 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 5.00 SO, FT. FLOOR AREA TOTAL ACREAGE' himself or through his own employees, provided that such improve. menta are not intended or offered for Sala If, however, the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is Sold within one year of completion, the owner builder will have the burden of proving that he did not build or an, prove for purpose of sale.). ❑ I, as owner of the properly, am exclusively contracting with licensed contractors t0 construct the project (Sec. 7044, Business GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB' Omer INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 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 contracts for such projects with a contractorts) licensed punund to the Contractor's License Law. ❑ I am exempt under Sec.-, BAP.C. for this reason LAWN SPRINKLERS - OVER 5 (EA.) 1.00 .� SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. �' r PARCEL NO. WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACG. FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent 1. self -insure, or a certificate of Workers' Compensation Insurance or a cerciEcd ZONING ENG. SITE NO. copy thereof (Sec. 3800, Lab.CJ. - Policy No. Company FIRE SPRINK Y0 N ENERGY T 24 Y0 N[] '❑ Cerified copy is hereby furnished I �K-Certltl�el,,eO�py IS fll d Wlth BI City inspection division. AppBcant��� pC�W�1:' MISC.- REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. PLG. CONTR. LIC. NO. PLG. TOTAL COMPENSATION INSURANCE. (This section need not be completed if the permit is for one Y� N� Y� N❑ OTY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars IS 100) or Icss.) I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so as to BUILDING become subject to the Workers' Compensation Laws 01California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of F.- emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10AMCF.M.) 4.00 AIR HANDLING UNIT (OVER 10=CF.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, CR.CJ. Lender's Name EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC �% Q d Lender's Address I certify that l have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and VENTILATION FAN (SINGLE) 4.00 PLUMBING BOILER -COMP 13 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We). gree to save, indemnify and keep harmless the City of tsud ments, costs and expenses which Caper ag5g�e'caga' me I any said City in consequence of the t gaf[h AneTOTAL MISC.- REFER TO ORD. CONST. TAX PERMIT ISSUANCE10.00gr MECH. CONT. LIC. NO. MECH. TOTAL Signature of Appl 'a /Co frac Date OFFICE COPY