17839 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDING PROJECT 1 DENTI FICATI ON PERMIT NUMBER
BUILDING APPLICATION & PERMIT 7p39
ADDRESS - I UU J
2050 A(LDT _ 51 _ CI �- ING - ELECTRICAL-PLUMBING-MECHANICAL
OWnER'I 1 /r I 1^,,r . PLAN CHECK VALIDATION
"AME L/'x Yl✓I�w �{�• �/1 OTY. ELECTRIC PERMIT FEE T DNE 19(04
rci°i"uE"Ac " �eW OUTLETS-SWITCHES-RECEP 10.00/1.00
uc.N LIGHTING FIXTURES - 10.00/1.00
no"'"uTOO"9J/ -D PPLIANCES-RESIDENTIAL 4.00
PNOne PANELS - 10.00 DATE OF APPLICATION
OR
TELT PANELS (OVER 200 AMP) '20,00 PLAN CHECK FEE P,C.NO.
ENGINEER
u1
LIC rva. SIGNS TRANS. '3.00
nooa�ErS CA B"G' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP. METER OR POLE INS. 20.00 --C a,
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANG 1J. 20.00 -
,02 LICENSED,CONTRACTORS DECLARATION �•"�C ' `�'`-
a z w I hereby affirm that I am licensed under provisions of Chapter 9 Y r - ISSUANCE DATE
f Di
ti
h S
i
i
commencng with 7000)of 3 of the Business and
¢ ( BLDG. ELECT, J PLG. I MECH.
F N z Professions Code,and my license is in full(arca and effect.
o imp License Cho. Lic.Number 1 0 ;III, I I
Date Contractor
L ac
¢ m BUILDING PERMIT
¢ ¢ OWNFR-BUILDER DECLARATION'
o a " MISC.- REFER TO ORD INFORMATION
w3 I- 1 hereby affirm that 1 em exempt from the Contractor's License
u0 law for the following onsun.(See 7031.5.Businessand Profesnms VALUATION
L - M Code:Any City or county which reyuiresa permit mconstruct.alcor. PERMIT ISSUANCE 10.00 -} /y�/� 7
¢ improve,dmnduh,or repair any structure,prior to i6 issuance,x150 ELEC.CONTE. LIC.NQ ELEC. 51(D I L I /CCO
veO , requires the applicant for such permit to IIIe a signed slatement that TOTAL PERMIT TO
$ he is licensed pursuant to the provisions of the Contractor's License
Uzi
Law(Chapter 9(commencing with Section 7000)o1'Division 3 ofthe
¢ Businev and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ I
s- O the basis for time alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n3 � by any applicant for a permit subjects life applicant to a civil penalty 00 ALTER-DRAIN IEA.) 5.
of not more than five hundred dollars($500).): ALTER- V-M
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP HES.UNITS
their side compensation,will do the work,and the stoners a is not -
intended or offered for sale (Sea 7044, Business and Profnsions• DRAINS-FLOOR,ROOF,AREA,COND. 5.DO _71 .I
Code:The Contractor's License Law does not apply to an owner of `✓�
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5,00 - SO,PT.FLOOR AREA TOTALACREAGE
himself or through his own employers,provided that such improve.
ents are not intended or offered for sale.if however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- AS- A SVST M- 4 ( v
builder will have the burden Of proving that Ile did not build or im- BUILDING USE
prove for purpose Of sale.). 30. 0 -RIES/IND CON PB Omer
❑ 1,as owner of the property,am exclusively contracting with [P El El 1:1 El
licenud cnntructurs In construct the project(Sea 7044.Business 6.00 ASSESSORS PARCEL NO,
and Professions Code:The Contractor's License Law does not apply _
to an owner of property who builds or improve therefor..it who U EP13JUVPRN*X)IIII, 1'.00
commcls for such projects with a contractors)Iiccnmd pursuant to
the Contrie ori License Law. SE N Y$ 0ft/i 0.112 TRACT NO. PARCEL NO.
❑ 1 um cxempl undv,Sec. ,B.&P.C.for this W
reason
Owner Date WATER SYSTEM ' 5.00 ACC.OATF ACG FILE NO.
WORK ERS'COAIPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 herby affirm that 1 have a certificate ofconsent to sel Gin,mr. ZONING
or a cerlifcate of Workers Compensation Insurance,or a certified ENG.SITE NO.
cops thcreof(Sec.3800 b.C.).
Policy No. Pant'
❑ CcrfilmJ copy 5' ercby fumiilmd. FIRESPRINK ENERGYT-24
Z Z A❑ Certified c Is filed w'tlf7 the ty inspects division. MISC.- REFER TO ORD. ' Y N v N
O a ❑ ❑ ❑ ❑
1- wPERMIT ISSUANCE 10.00
� '1 ,\'fIi OP l',41( TI �R )AI WORKISRS' IZ - FLOOD ZONE A.L.U.C.
W > COMPENSATION INSURANCIi PLG.CONTE. LIC.NO. PLG.
(P
his section need not be completed it the permit is for one TOTAL 61 YE] I+❑ Y,F] NE]
Z
hundred dollars(S 100)or lass,)
U O 1 certify that in the performance of rhe work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL Umit is issued, I shall not onplor any pelmn in any mnner
aso us to
Become subject to the N'orke,,'Campcnsation laws of Cvliforia. ^
0 i Dmc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING ^�
1-rf
} r0 NOTICE TO APPLICAM': If,after making this Certilcale of mix-
Z emption,you should become subject In the Workers'Compensalion APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Colic, you must forthwith comply with FEE
U such provisions or this permit shall be domed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONS1'RUCI ION LENDING AGENCY AIR HANDLING UNIT(OVER J0=CEM) 6.00 SEISMIC FEE 8 ,_
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. MICROFILM
3097,CivC.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lenders Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 5I
Lender's Address ELECTRIC _
1 certily that 1 have read this application vnd state that the above VENTILATION FAN (SI NGLEI 4.00
s� information is correct. I agree to comply with all city and county MPPLUMBING
ordinances and state laws relating to building construction, and BOILER-CO (3 H.P.or 100,000 B.T.U.) 6.00 5I
^' hereby authorise representatives of this city to enter upon the BOILER COMP IDp�.l (p
ahove-mentioned property for inspection purposes. Vaf 100,1X%1 BTU)SEE FEE SCH. MECHANICAL S
(We) agrtt t indemnify and keep harmless the City of MISC.- REFER TO ORD.
ye' - -
upernno at 'Sbilities,judgttents, costs and expenses which
v is an a accrue s said Cit in conse once the PERMIT ISSUANCE 10.00 12 ._ CONST.TAX /�
anling O t ut - //s( MECH.CONT. LIC.NO. MECH.
y � iLrf/y 1g7.G' , TOTAL
�I TOTAL /
to of Applicv t/C n� tractor D AAa LLI
OFFICE COPY 1/ f/