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17834 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION - • ,PERMIT NUMBER BUILDING 9 APPLICATION & PERMIT 17834 •oon�-C�[��Q UI LDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S vI V - PLAN CHECK VALIDATION NAME OTV,. ELECTRIC PERMIT FEE • FVQK-TI E3 RGNET5 9Lo� NAME CONTRACT. f�� / �b�IJ�V UTLETS-SWITCHES-RECEP 10.0011.00 LIC.No. s3 LIGHTING FIXTURES 10.00/1.00 ADDRESS TORPC7 /J/� W APPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 10.00 DATE OF APPLICATION OR .cT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.Q=O. ENGINEER LIC.No. SIGNS TRANS. 3.00 ARCHR.OENG . ='RMIT VALIDATION ADOREsSPECIAL CIRCUIT 5.00 ZIP EMP.METER OR POLE INS. 20.00 ( �D APPLICANT'S - ADDRESS MOTORS SEE FEE SCH. - - r{ ///• SERVICE CHANGE 20.00 n J F►'o LlG LI , o o LICENSED CONTRACTORS DECL\RA'f10N � 3 1 - 1, 'V^�// u 0 1 hereby affirm that 1 am licensed under provisions of Chapter 9 `� �Z ISSUANCE DATE y a (commencing with Section 7000)of Division 3 of the Business aad t BLDG. ELECT. PLG. MECH. H 4 z Professions Code,and my license is in full force and effect w A 1 Ne i o 2 - License Class Lic.Number 9 a H w Datc Contmaor \�\ `Lt"� g k3 Z- ¢ 'c ¢ a OWNER-BUILDER DECLARATION of Cnnarfin(► BUILDING PERMIT Aa=" MISC.- �� �• REFERTOORD INFORMATION ea ;LL F 1 hcrcb`y million Ihul 1 am exempt Irma the Contractor's s License VALUATION S/FT. F LL o a Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 12 _ Code:Any city or county which requiresa Perot toconstuta,alter, �7 /-� R2 4 improve,demolish,or repair any structure,prior to its Issuune,,also ELEC.CONTR. LIC.N0. ELEC. �� CD I L� VOO po u requires the applicant for such permit to file a signed statement that TOTAL a Wply he is licensed pursuant to Lire provilsions of the Contractor's License PERMIT TO H Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe a Business and Professions Code)or than heisexemY. pt therefrom and OTPLUMBING PERMIT FEE S L' ¢ = $ the basis for the alleged exemplim,Any violation of Section 703 LS1 STORIES TYPE CONSTR. s ; by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER (EA.) 5.00 V-N of not mor,than five hundred dollars 1$5001.1'. ❑ 1,as owner of the prperty,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure n not intended or olfered for sal, (Sec. 7044,Business and I'rofenions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 K_7,- , 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:FT.FLOOR AREA TOTALACREAGE e himself or through his own employees,provided that such improve- /� V-- Fields are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 1 NC.4 OUTLETS 6.00 I GQ� `i16 nv� or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 ' ✓CCJJ BUILDING USE 4CD builder will have the burden of proving that he did not build,or im- prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON ,PB other Cl I,irs owner-of t11c property,am exclusively contracting with ❑ ❑ ❑ ❑ Q. licensed contractors to construct the projeci 1Sac. 7044,Business LAWN SPRINKLERS-1'INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts forsuch projectswith a contranorls)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. the Contractors License Law. ❑ I am exempt under Sec. .N.&P.C.for this WATER HEATER W 6. reason Owner Date WATER SYSTEM C.DATE ACC,FILE N0. ' WORAISRS'COMI'IiNSAT10N DECLARATION WATER TREATING O I I hereby affirm that [ have a mrtifcate ofconsent to self-inNoe. or a certificate of Workers'Compensation Insurance,or a certified ZONIN ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). DATE. ; Pmiey Nss CO CReny 9 . O ❑ Cerlilied copy •by Hruisl1ed. FIRE SPRINK A IIn ENERGY T 24 Z ZO ❑ C Wiled co o bled wit )te ci inspection division. MISC.- REFER TO ORD. _ Y E] N❑ Y'❑ NE]c � CC run ✓1 1 F PERMIT ISSUANCE 10.00 FLooO zorvE A.L.U.C. '� CliICATIiO YIiA N PROs WORK :RS' 1zJ. - LU Q COMPENSATION'INSIIRANCI. PLG.CONTR. LIC.NO, TOTAL 51�� Y E] N❑ V❑ N❑ 1'I his section need not be completed if the permit is for one Z) Z hundmdd"Ilars(Sl00)"A11.) U 0 1 certify that in the performance of time work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued,1 shall not employ any person in any manner w as m O w become subject to the Worker Compensation Laws Of California. y Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } run NOTICE TO APPLICANT; IL aNcr making this C,nifieme of Fs- � Z ,mption,you should becom,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 be deemed revoked. AIR HANDLING UNIT(TO 10SWC.F.M.)'. 4,00 CONSI'RUCTION'LENDIN(i AGENCY AIR HANDLING UNrNOVER 10MC.F.M.) 6.00 - SEISMIC FEE _ 1 hereby affirm that then is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which the permit N issued(Sec. MICROFILM �- 3097,Civ.G). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Address Lender's Address - HEATING UN IT IOVER 100,000 B.T.U.)9.50 ELECTRIC 51 1 certify that 1 have read ffinapplication and state that the above VENT I ENTI LATI ON FAN (SINGLE) 4,00 • • information is emrreel. I agree m comply with all city and eFunty PLUMBING Ordinances and state Inws relating to building construction, and BOILER-DOW(3 H.P.Or 100,000 B.T.U.) 6.00 -� hereby authorize mpra�wyntatives of this city to enter upon the BOILER-COMP (Over 110,000 BTU).SEE FEE SCH. MECHANICAL t ve-mentioned pro / for inspection purposes. q 51 We) agree to vie,/indemnify and keep harmless the City of MISC.- REFER TO ORD. J ertino ugai t I` !litres,judgments, costs and expenws which PERMIT ISSUANCE. 70.00 CONST.TAX /y'l in any accrue inst 'd City in conseyuanc of the 1•Z - 3 a.• /,�" Ii go sp,rtnIL L MECH.CONT. LIG NO. MECH. - 3 TOTAL 51�$ TOTAL (o are of, t/Contractor 15.1e ' / 9 OFFICE COPY