3603 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
PER T NUMBER
BUILDING PROJECT IDENTIFICA APPLICATION & PE
ewLotNG.
, nOORE55 OO/^ O
BUILDING Pq V- 3n
YYOwNER'a - PLAN CHECK VALIDATION
NAME O^
G QTY. ELECTRIC PERMIT FEE
ONE
CONTRACTOR S ,/
NAME �k1 C4 �,��8 UTLETS-SWITCHES-RECEP 5.00/1.00
sec.No. L L IGHTING FIXTURES 5.00/1.00
rorvTRA Tons PPLIANCES-RESIDENTIAL 4.00
ADDRESS 9
7� PHONE�� �� PANELS 5.00 DATE OF APPLICATION
ORRCHITCT SIGNS 6.00 - PLAN CHECK FEE PG.NO.
ENGINEEn
Lt..No, SIGNSTRANS: 3.00
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS /) _ SPECIAL CIRCUIT 5.00
EMP.METER OR POLE INS. 15.00
APPLICANTS
ADDRESS MOTORS SEE FEE SCH.
9 SERVICE CHANGE 10.0
- P;��/�
o o LICENSED CONTRACTORS DECLARATION 3
a v w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
fconmtcncin,with Suction 70W)of Dieieo 3 of the Bus n•s set
G rt y } BLD E T. PLG. MECH,
F O Prolessiom Code, y license I,in full to
J'
0O License Class_ Lic.Number 77
9 � � Dme���Convuctnr Eff
r
¢ o n D OWNER-tlUILUISR DECLARATION MAY �+ D " ZONRMIT
w ; LL 1 hereby xfGnn that I um exempt from the Contractor's License MISC. - REFER TO ORD
u0j Law for thefollowingreawn.(See.7031.5.Business and Professions VALUATION 5/FT.
- PERMIT ISSUANCE s.00 C y1Cef�Upertino
m y Cale A.de icy or County whiny rcquirLsa permit toconsuan e,also
¢ ¢ ¢ 0 intprov4 dentoligh,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
0¢ requites the applicant for such permit to file a signed statement that TOTAL PERMIT TO
K
$ he is licensed pursuant to the provisions of the Contractor's License
Hzi Law(Chapter 9(commuming with Section 7000)uf Division 3ofthe 0� JIM-
Business
p7th�L
14Business and ProfessioCalc)or that he is exempt Iherum and QTY. PLUMBING PERMIT FEE `W/
. 10 the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
d � by any more that fore pudre dollars(fie applicant macivil penalty ALTER-DRAIN -WATER (EA.) 4.00
,f not more than five hundred dollen fS500).):
O [.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 COND. 4.00
Code The Contractor's License Law does not apply to an owner of
plOpCrty who builds l,I Improves thC,.n,and von,dM5 such work FIXTURES-PER TRAP 4.00 -ua FT.FLOOR AREA TOTAL ACREAGE
gh Mmes armor intends own emphoyccsuk.Iprovided however,the
improve. GAS-EA.SYSTEM-I INC.4 OUTLETS 4.00
mems are not intended or thin on far sok.If,however,the building
or)der deem is sold within one ycer of lie did Ect the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 1,00 BUILDING USE
builder will have the burden ul'pruvmg that he did not build or in r RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00
❑ 1,as owner of the property,am exclusi,Cl,.contracting with ❑ ❑ -❑ ❑ ❑
licensed contractors to construct the project(Sec. 7144,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
add Professions Code:The Contractor's License law does not apply
to an owner of property who builds or improais thereon,and who LAWN SPR IN KLERS-OVER 5IEA.) 1.00
contracts fur suah pn'jco,with a con trader Sl licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ 1 am t
ex� rtp�ndl�,•c.�c B.&P C.for this
reasonC� {.. A/ WATER HEATER W/VENT 4.00
Date A 9 owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO,
WORK ERS'CO.MP1iNSA'I[ON DECLARATION WATER TREATING EQUIP. 4.00
1hereby affirm that 1 have a certificate of consent to sell-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG,SITE NO.
copy thereof(Sec.3800, -
Policy No. Company
O ❑ Certifiedcopyisherebylumish Cd. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy Is filed with the city inspection division.
O Applicant MISC.- REFER TO ORD. Y,❑ N❑ Y ❑ N❑
~ vaPERMIT ISSUANCE
W ?