Loading...
17827 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY PERMIT NUMBER BU I LOING PROJECT IDENTIFICATION' BUILDING l/• OE If'�jZ (�Ui1t APPLICATION HPERMIT OGRESS t1LDING -ELECTRICAL-PLUMBING -MECHANICAL F� 17827 20&�Pr, 7RA710& rJ OWNERS L(Al1 DTV. ELECTRIC PERMIT PLAN CHECK VALIDATION FEE PHONE NRsd NAME � �G UTLETS-SWITCHES-RECEP 10.00/1.00 LIC,NO IGHTING FIXTURES 10.00/1.00 ADDRESS Rs q/ PPLIANCES-RESIDENTIAL 4.00 AZ�oPHONE.%-,�/ PANELS 10.00 DATE OF APPLICATION _ AOR " ECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE .c.rvo. ENGINEER uc.No. SIGNS TRANS. 3.00 AR. ENG. PERMIT VALIDATION ADDRESS ss _ SPECIAL CIRCUIT 5.00 , ZIP EMP.METER OR POLE INS. 20.00 �_� `/_9d ADDRESS ACTORS SEE FEE SCH. ( APPLICA ICE CHANGE FWD 20.00 Foo LICENSED CONI'RACfI`//��=- Q 2 u 1 hereby uflinn Thal am licens�/Isii �Q ISSUANCE DATE H a w (commencing with Section 70001 OI Division 3 0l the usmef R BLDG. ELECT. PLG. MECH. MAY " h z Professions Code,and my license is in •and effect 7 z o m - Liccnsc Clan Lia N rm ,w Dam contractor Cit/ of '"n no N, m I BUILDING PERMIT ¢ a a OWNER-BUILDER DIiCLA RATION o> " MISC.- REFER OORD INFORMATION X 3 LL r 1 hereby affirm that 1 am exempt from the Contractor's Licenses VALUATION VFT. ta Is O� Law for the following rcasu¢(Svc,703L5,Businessand Professlmn PERMIT ISSUA C 10.00 Code:Any city or county which rnpJresa,Cohn loconstruct,alter, I R ¢ ¢Q improve,demolish,or repair any structure,prior to its issuanm,afw ELEC.CONTR. L .NO. ELEC. '/.7' D u requires the applicant for such permit to Ills a signed statement that TO AL 5I PERMIT TO E he is licensd pursuant to Ibe provisions of the Contractor's Lie rove " iQ Low(Cllapter9(commencing with Section 7000)of Uivisian3ofthe F-yI '1 i LI Business and Professions Code)or that he is cxcm Pt therefrom and Q Y. P UM I E EE ¢s- the bvsu for the Alleged exemption.Any violation of Section 7031.5 STORIES TYPE COrvSTRe u ; - by any applicant for IT pemtit subjects the applicant Wa civil penally LTER-DRA EN -W E EA. v�Is..l of not mom than five hundred dollars(S500)J: ❑ 1,as owner of the property,or my employees with wages as PACK FL P TE E 4 0 OCC.GROUP RES.UNITS sole compensation,will do the work,and the stmcmre is not intended or offered for sale (Sec. 7044, Business and Prolessto., DRAI F ,R F E CON 5. 0 3 Coda:The C,HRokmi s Licenw Law docs not apply m un owner al' property who builds or Improves thereon,and who docs such work IX -PER 1 5. 0 SO.FT.FLOOR AREA TOTALACREAGE • himself or through his own employees,provided that such improve- A ./ 1 C.4 U S 5. 'C.�-7 6r'Qr AM merits are not intended or offered for sale.If,however,the building :J / or improvement is sold within one year of completion,the owner- S-E V -O E E 2.00 builder will have the burden of proving that lie did not build or inh- BUILDING USE prove for purpose of sale.). DUST I ASTE I TE 30.00 RES IND CON PB Owes ❑ I,as u r of the properly,am exclusively contracting with rLJ' ❑ ❑ ❑ ❑ licensed contractors to construct the project see.7044„Business LAWN SP KLERS- 1 INC 5 V B. 6.00 ASSESSORSPARCELNO. and Professions Code:'I'lie Contractor's License Law docs not apply to an owner of property who builds or improves Iherann.and who LAWN SPRINKLERS-OVER 5-(EA.) 1.00 eonlracts for such projects with a contraclogsl licensed purvmnt to SEWER-SAN V-STORM EA.200ft/10.00 the Contractors License Law. TRACT NO. PARCEL NO. ❑ lam exempt under Sec. ,B.&P.C.far this ,WATER HEATER W/VENT 6.00 rea50n Owner Date WATER SYSTEM 5.00 "' ACG DATE ACC.FILE NO. WORK 17 RS'COM PENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby alfirm that I have a certificate of consent m wit rv,ure' �� - ZONING ENG.SITE NO. a cetlific-ate of Workers'C mpenvti.R Insumncc,or a ceitit ieJ spy thereof IScc.3800, .C.).Polk No. C any - ❑ Cmtiticd copy' Baby fqurn J. FIRE SPRINK ENFRGr,L24 . Z = ❑ eRificd c is filed At he inspection division. MISC.- REFER TO ORD. O App nt r ❑ N❑ V ❑ N❑ CC w I 'ICAT'EOP EX k 10, FROM WORKERS' PERMIT ISSUANCE 10.00 12-- FLOOD ZONE A.L.U.C. W > COb1PEN'SATION INSURANCE PLG.CONTR. ❑c.NO. PLG. C (0CL 0 Y❑ - N❑ Y❑ N❑ (This .vection need not be completed'if the permit is for one - TOTAL :J hundred dollars($100)or less.) U O 1 certily that in the performance of the work for which this per- Qty MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers Compensation Laws of California. �'ad Dalc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING >_ H NOTICE TO APPLICANT: If,after making thh Certificate IT - - ? enhption,you should become subject to the WorkersCompensation APPLIANCE 5.00 PLAN CHECK provi mis of the Labor Code, you must forthwith comply with FEE ` U .rich provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1Op00CF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER l0fMC.F.M.) 6.00 SEISMIC FEE ,8 Courcby affirm that there ot a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the pa,formance of the work fur which this permit is nsucd(Sce. MICROFILM - 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 - Lcndcr'sName HEATI NG UNIT 100,000 B.T.U.)9.50 "JI Cob Lender's Address ELECTRIC I certify that I have read this appllcatiun and state that the above VENTILATION FAN (SINGLE) 4.00 CoS information is correct. I agree to comply whlh all city and county' PLUMBING 15 ordinances and slate laws reaming to-hiilding construction, and BOILER'COMP(3 H.P.or 100,000 B.T.U.) 6.00 5 -' herby aulhurim mpresentatives of this city to ewer upon the BOILER-COMP IOeer iw,OW BTU)SEE FEE SCH. MECHANICAL 51 f0 above entionedproperty for inspection purposes. (Wc) egreo VV-'re, indemnify and keep harmless BIc City of MISC.- REFER TO ORD. _ upertino a i t tiebilities,judgments, cost, and expenses which CONST.TAX ry vy in a oy ace aqui said City in tone( rice C the PERMIT ISSUANCE 10.00 Ia ,-,� /�. / anon Lhis Re MECR.CONT. LIC.NO. MECH. �/ TOT"51 66 TOTAL / /0•G� alurc of pliant Contractor Ua e 5 OFFICE COPY