17838 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT I DENTI FI CATION PERMIT NUMBER
gO,Lp,„G Lb 33C APPLICATION & PERMIT 17838
BUILOu5
i S BUILDINGELECTRICAL- tt,.
OwNEH'S ' A 1 ' 1,. 1/ PLAN CHECK VALIDATION
NRME 4HN �-y- EIQTY. ELECTRIC PERMIT FEE
• DNE 1 91o�4�
NAMEn.NRnc OR W1UTLETS-SWITCHES-RECEP 10.0011.00
'�Uc. O /Q LIGHTING FIXTURES 10.00/1.00 '
f-DNTRACTOR ��✓ r/r APPLIANCES-RESIDENTIAL 4.00
A RES9 Ci/ ��" -
_ PHONE- PANELS 1
OR 'TECT PANELS (OVER 200 AMP) 20. c FE C.NO.
ENGINEER
LIC,No. SIGNS TRANS. 3.
nooHEss ENc. SPECIAL CIRCUIT 5.00 r N
ZIP EMP.METER OR POLE INS. 20.00 �� `''1 �6
Aa MOTORS SEE,FEE SCH.
APPLDDRmIC5A5rfir1
SERVICE CHANGE 1 20.00 7
1 w/
H o a LICENSED CONTRACTORS DECLARA'TON - - zJ/
G v u I hereby affirm that I am licensed under provisions of Chapter 9 Or ISSUANCE DATE
yd frommencing with Section 7000)of Division 3 of the BUsin.and
a BLDG. ELECT. PLG. MECH.
H m i Professions Code,and my license is in full forand effect.z o w - License Class Lie.Number,
mw Date Contractor
`- City of CRnntioo,
a ,a f BUILDING PERMIT
m � a OWNIiR-BUILDER DECLARATION
o d D INFORMATION
X ; m I hereby affirm that 1 am exempt from the Contractor's License' MISC.- REFER TO ORD
L, O J Law for the following reason.(Sec,7031.5.Bodrucsnnd Professionsy y Or VALUATION SIFT.
P
r - Code:An cit ourd,
ISSUANCE 10.00
ywhich requiresapermit to aonstrve,alleq
a a 0 smpwv0.demolish,or repair any sl reel ere,prior to its uumnec,alw ELEC.CONTR. LIC.NO. ELEC. ✓J Ly1
u w0 LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
he is lieemcd pursuant to the provisions of the Conmdtor's License
Law(Chapter 9(commencing with Section 7000)ofDivismn3 ofthe C (II
Z i 0 Business and Professions Code)or How he is exempt therefrom and QTY. PLUMBING PERMIT FEE JCI �'l
2 H the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
e- 3 by any applicant for a Permit subjects the applicant tna civil PcerIly
of not more than five hundred dollars(55001.1: ALTER-DRAIN& VENT-WATER (EA.) 5.00 ISI
O I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 DEC.GROUP RES.UNITS
their we compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 70,14. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 -7J
Code fhe Contractor's License.•law does not apply to an owner of
property who builds or improves thereon,and who docs such work F IXTUR ES-PER TRAP - 5.00 SO,FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,Provided that such improve- r ,A
mums are not intended or offered for sale.If,however,the building GAS-EA,SYSTEM-11NC.4OUTLETS 6.00 Idg/�
or improvement Is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 1 BUILDING USE
builder will have the harden of proving that Usti]not build or int- /
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES MO CON PB Other
❑ ' ❑ El 1:1O 1,as owner of the Property,are CxCluslvCly contracting with �
licensed contractors to construct the project ISec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for umh Projects with a conlractnr(s)licensed paHcunt to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCELNO.
❑ lent exempt under Sre. .B.&I'.C.fur this WATER HEATER W/VENT 6.00
reason
Owner [)ate WATER SYSTEM . 5.00
ACC.DATE ACC FILE NO,
WORK ERS'COMPENSA'IION DECLARATION WATER TREATING EQUIP. 5.00
I hereby alarm tout 1 have a cartiftcWc of concent to self-insure. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thercoffSee 380q, yb.CJ.
Policy No. any
❑ Certified cn ix mchy furni.vhad. FIRESPRINK ENERGY T.24
z = A❑ Certified k filed'wit the c' inspection division. MISC.- REFER TO ORD. �j r N Y N
O ❑ ❑ ❑ ❑
.IFI ALIS P li : 1 Ft 1 O PERMIT ISSUANCE . 10.00 IZ 271
FLOOD ZONE A.L U,C.
LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. /saQ r❑ N❑ Y ❑ ❑
CL Z CI los section need not be completed if the permit is for one TOTAL `T 1 N
hundred dollars IS 100)or Iess.1
U O Leertify that in the perfomwnce of the work for which this per- Q�y MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is hsm
wd,I shall not employ any person w m
in any manner as
Q become subject to the Workeri Compemation Laws of California. n�v_
W Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 0..1L1 '.-
} to NOTICE TO APPLICANT: I(;after making this Certificate of Ex-
Z 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 '-
U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AG17NCY AIR HANDLING UNITIOVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) i 5.00
the perfomwnce (If the work for which this pennit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,007 B.T.U.) 8.00
Lender's r ddH EATING UNIT(OV ER 100,000 B.T.U.)9.50
Lender's Address
Address ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 - 1)y'
information•is correct, I agree to comply with all city and county PLUMBING r
ordinances and state laws relating to building construction, and BOILER-OO P(3 H.P.or 100,000 B.T.U.) 6.00
hereby rothoertfim i<c mTeHcntat representatives of this city to enter upon 'he BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL q-� 0�
above-mentioned propCtlyf.,inspection purposes.
• (We) ag c to ,yytve indemnify and keep harmless the City o1 MISC.- REFER TO ORD. i ^ I
upertnto ag ' t1i lilies,judgments, costs and expenses which PERMIT ISSUANCE 10,00 . 12, CONST.TAX �d 74
nay in any fay ccrue�inst feid City in con , once the /
ranting o ermlt. MECH.CONT. LIC.NO. MECH.
TOTAL 9CE5 TOTAL c.{/
re o Applicant/ onlractor Datea-} J / /I
OFFICE COPY