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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI LDI NG PROJECT I DENTI FI TION
APPLICATION & PERMIT
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
PERMIT NUMBER
-
7142
BUILDING �„
AD Ess
lJ
OWNER'S
NAME..
r
ry, ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
PHONE
NOMTRAOrons
UTLETS-SWITCHES-RECEP 5.00/1.00
-J uc. No
LIGHTING FIXTURES 5.00/1.00
- DATE OF APPLICATION
ADDRESS oR
6
p yG ' PHONE (�J�
PPLIANCES- RESIDENTIAL 4.00
PANELS 5.00
ARCHITECT
ENGINECH
L.C. No.
,SIGNS 6.00
PLAN CHECK FEE P.C, NO.
SIGNS TRANS. 3.00
ARCH ess ENG
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
TEMP. METER OR POLE INS. 15.00
ZIP
APPucANT'a
DDRESS
-
MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00
LICENSED CONTRACTORS DECLARATION
_
I hereby affirm Thal I am licensed under provisions of Chapter 9
Immmcrlcing with Section 7000) of Division 3 of the Business zind
Profmions Cody,nd my license is in fall fore n e1..,
Limslx C ass /.S / Lic. Number s TO
ISSUANCE DATE
BL \fi T. PLG. MECH.
- ..
Ualc
.
LDING' PERMIT -
INFORMATION'' 'rr)
r�-T2_�Cunlranor _-'?--'
OWNER -BUILDER DECLARATION
I hereby affirm that 1 exempt from the Contractor's License
Law for the following reason. (Sec. 7031.5, tl not to antl t rnfesdons
Calc: Any city or county which striturpermit to construct, after,
improve, he applicant for air any suhprstructure,ittiprior a ned Stssuance,atement 8B0
requires theapplicantfor suchpermitto lila a5Cont statement i that
Ge is Cluiphe pursuant m the provisions of the Contractor's License
Law IClmpter Y 1 commencing with Section 70001 of Division J of the
1 MISC. -' REFER TO ORD
PERMIT ISSUANCE g 00
I$J )iL t'2. Igo
(/C/
UFT.
ELEC. CONTR. LIC. NO. ELEC.
� TOTAL
PERMIT TO
L
Business and Professions Code) or that he is exempt therefrom and
CITY. PLUMBING PERMIT FEE
DIn basis for the alleged exemption. Any violation of Section 7031.5
by any applicant for a permit objects the applicant to a civil penalty
of nut more than five hundred dollars 1 S500).):
STORI s
TYPE CONSTR.
ALTER -DRAIN -WATER (EA.) 4.00
❑ 1, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 2.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA COND. 4.00
intended or offtmd for sale (Sce. 7044, Business and Professions
Code: 'I he Contractor's License Law don not apply to an owner of
prolwrty who builds or improves thereon, and who docs such work
himself or through hisown employm,provide) that such improve-
menu are eat intended or offered for silt. If, however, the building
FIXTURES - PER TRAP 4.00
GAS-EA.SVSTEM-11NC.40UTLETS 4.00
Bo. rr. FLOOR AREA
TOTAL ACREAGE
or improvement is sold within one year of completion, the owner-
bwldor will have the burden of proving that he did not huild or im-
i GAS- EA. SYSTEM - OVER 4 (EA.) ' 1.00
BUILDING USE
prove for purpose ofsalc.).INDUSTRIAL
El. I, as owner of the properly, am exclusively contracting with
RES' IND CDN PB Omer
❑ ❑ ❑ ❑ ❑
- I WASTE INTER2000
licensed contractors to construct the project (Set. 7044, Busilac
and Professions Calc: The Contractor's License law does not apply
to an owner of properly who builds or improves thereon, and who
LAWN SPRINKLERS - 1 INC 5 V.8. 5.00
LAWN SPRINKLERS - OVER 5 (EA.)1.00
ASSESSORS PARCEL NO.
con Contractor's License Law.
the Cons for su Licenenxwith acontradortsl licensed pursuant to
❑ lam exempt under Sec. ,B.&P.C'for this
reason
SEWER -SANITARY -STORM EA. 200ft/8.00
TRACT NO.
PARCEL NO.
WATER HEATER WNENT 4,00
Owner Dal'
WATER SYSTEM 4.00
ACC. DATE
ACC. FILE NO.
WATER TREATING EQUIP. 4,00
WORK ERS'COM PENSATION DECLARATION
I hereby utfirm that 1 have a certificate ufeonsent to wilainsure,
or a certificate of Wofkerti Compenemion Insurance, or a certified
ZONING
ENG. SITE NO.
-
Copy thereof (Sec. 3800, Lab C-.).
Policy No 4 Company
FIRE SPRINK
Y ❑ N❑
-ENERGY Tdd
Y ❑ N❑
❑ Cenif Ind copy is hereby furnished.
❑ Cerified copy -is filed with the city inspection division.
Applicant
MISC. - REFER TO ORD.
CERT IFICATE OF EKF,MPfION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed if the permil is for one
PERMIT ISSUANCE 6.00
FLOOD ZONE
Y ❑ N ❑
A.I_U.C.
Y ❑ N ❑
PLO. CONTR. LIC,NO.
I.G.P
TOTAL
hundred dollars IS 100) or lef
the perfommnce of (he work for wh'
I certify that h m
mil is issued, I shall not eploy pension neer '(o
he, Ln
Date.l�f.,f-AYApplic
NOTICE IO APPLICANT: a to thin Ctrlif a of Ex-
a
ATV. MECHANICAL PERMIT FEE
FEE,SUMMARK,,.:'i
- r
BUILDING
ALTER OR ADD TO MECH. 4_00
APPLIANCE 4.00
AIR HANDLING UNIT (TO 10=C.F.M.) 3.00
PLAN CHECK
FEE
" 7
emption, you should hcco bb,t the Workerx' C npl:nsatio.
provisions of the Ubor C e, oa must forthwith comply with
such provisions or the permit . 11 Ms deemed revoked.
AIR HANDLING UNIT (OVER 10p00CF.M.) 5.00
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for
the pl:rhmname of the work I'or which the permit is issued (See
3097, da.C.).
EXHAUST HOOD (WITH DUCT) 2.00
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 4.00
Lender's Name
Lender i Address
H EATING UNIT (OVER 100,01x1 B.T.0-)7.50
ELECTRIC
VENTILATION FAN (SINGLE) 3.D0
I «reify that I Clave lead (his application and state that the above
it !carnation nL rrect. I agree to comply with all city and County
ordinances andstate lows relating to building construction. and
PLUMBING
BOILER -COMP (3 H. P. or 100,0008.T.U.) 4.00
hereby authomx representatives of this city to enter upon the
alwve-memo, d property for impeclims purposes.
BOILER -COMP Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
(We) r e to swe, indemnify and keep ha les the City of
Coperl no galvl liahili tics, judge t" costs d expenses which
yy1
may /In ny,�y aOtto ai9sYsnill Canof the
grant P If hii lmr './
v
MISC. - REFER TO ORD.
-
CONST. TAX
PERMIT ISSUANCE 3.00
ECH. CONT. LIC.NCL
MECH.
TOTAL
TOTAL
S at Net, /Cminstar, Date
OFFICE COPY