17825 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTIFICATI ON PERMIT NUMBER
RESIN - LOT 20 APPLICATION & PERMIT
ADOx 178 Z�
AooD
26G7� �{ A a-,CJI GC Qir+ UILDING - ELECTRICAL-PLUMBING -MECHANICAL
ONNEH'S 1WI�I] N PLAN CHECK VALIDATION
NAME 1�r K-+
.� T1I- �_j��_^30TV. ELECTRIC PERMIT FEE
PHONE J (.A
CONTRACTOR K Z � � UTLETS-SWITCHES-RECEP 10.00/1.00
uc.NO. LIGHTING FIXTURES 10.00/1.00
courRAcro '� Vzoe APPLIANCES-RESIDENTIAL 4.00
Ao (Ess
N PHONE - PANELS 1D.Qt) DATE OF APPLICATION
ORRCH Ecr PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE C.no.
NGINEER
LIC.NO. SIGNS TRANS. 3.00
ARCH OR END. SPECIAL CIRCUIT S.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
ADoADORE"
APPLICANT MOTORS SEE FEE SCH. L
SERVICE CHANGE 20.00
oo LICENSED CON'I'RACfOR Tlu
U��
¢ v I hereby affirm that I am IittnXdrMisID s o Tc 1 (� �y�+J ISSUANCE DATE
N Q (commencing with Section 7000)of s d BLDG. ELECT. PLG. MECH.
H 4D z Professions Code,and my license is in
II )
0'3 License Class Le N.
Dom Cnnm
l city of rdI0 - 1 P
OWNER-BUIDRI
CL BUILDING PERMIT
A a a" MISC.- REFER TO ORD INFORMATION
wLL I- I hereby affirm that 1 am exempt from the Conmctor's License
LL o Law for the following naso¢Se,7031.5,Businessand Pmfasions VALUATION E/FT.
_ g PERMIT ISSUANCE 10.00 �� E O
Code: e,dmtyor county re permitio oomnstmcl,alter,
¢ ¢ o improve,demolish,or repair any sWct ore,prior to its issuance,also ELEC.CONTR. C.NO. ELEC. `Y I
au o ¢ requires Ilse applicant for such penod to Glc a signed statement that .TOTAL _) PERMIT TO
E_
$ he is licensed pursuant to the provisions of the Contractor's License
H z i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe ��ss L-T�
¢ Business and Professions Code)or that he is exanpt therefrom and CITY. PLUMBING PERMIT FEE JI I1W L
¢ = 0 the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for u permit suh)ecls the applicant to a civil penally ALTER-DRAIN IEA.) 5.00
of not more than Five hundred dollars(5500).1: V-M
❑ I,as owner of the property,or my employee's with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will du the work,and the structure is not
intend04
Tiled or offered for sale (Sec. 74, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 19_7J
Code:The Contractor's License Law dos nal apply to un owner of ff
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP - 5.00 SO.ET.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
4Lme nos are not intended or offered for sale.If,however.lire building GAS-EA-SYSTEM-1INC.4 OUTLETS 6.00 14C'A� Z160or improvement is sold within one year of completion,the owner-hu
wner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 'T
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sure). INDUSTRIAL WASTE INTER. -30.00 [l RREES�IND WN PB Omer
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 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 prolwrty who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts forsuch projects with a contractors)licensed pursuant to SEWER-SAN EA.2001t/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
Cl I.....exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 '
reason
Owner nwo WATER SYSTEM 5.00 . ACC.OATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure.
or a certificate of Workcrti II�ontpcnmlion Insurance,or a certified b1 ZONING ENG.SITE NO.
Wpythercof(SL'c.3N00, .C.). -
Policy No. C puny
0 ❑ Ccrifcdcopy' by(umisha FIRE SPRINK ENERGY T 24
ZO
Ali lu Certified m Illcd with a ci msltction ivision. Misc.- REFER TO ORD. Y N Y N
n�l ❑ ❑' ❑ ❑
� N °ICAlf O FEXESIP}'ION FROM WORKERS' PERMIT ISSUANCE 10.00 Jsn- FLOOD ZONE A.L.1LC.
W >_ COMPENSATION INSURANCE PLQ CONTR. LIC.NO. PLG. 49 V� N❑ V ❑ N❑
d O (This section ed nm be completed if the permit Is for one TOTAL I
::) 2 hundred dollars IS 100)or less.)
U O 1 certify that in 01e perforn)wlee of tire work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
W F mit is issued,1 shall not employ any person in any manner so is to
U becnnto subject to file Workeo''CompellIA inn luuws of California. ��C'[j
U ED Dmc Applicant BUILDING -
} Vl NOTICE TO APPLICANT: If,alter making this Certificate of Fx- ALTER OR ADD TO MECH. 5.00
F 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 be deemed revoked. AIR HANDLING UNIT(TO 10,000OF.NL) 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 - SEISMIC FEE 33
1 hereby affirm that there is a construction lending ugeoay for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 -'
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.) i1q
Lenders Address ELECTRIC `-t
I ecrify That l have read thisapplication andstme that the above VENTILATION FAN (SINGLE) 4.00
rO�
information is correct. I agree to comply with all city and county
ordinances and state laws elating to building construction, and BOILER-COMPO H.P.or 100,000 B.T.U.) 6.00 PLUMBING
hereby authorize reprscnmtivef of this city to enter upon the BOILER-COMP IOvA,100,1100 BTU)SEE FEE SCH. MECHANICAL 4_I
ahovc mentioned 1, perry for inspection purposes.
(We) agree ve, indemnify and keep hannlLss the City of MISC.-. REFER TO ORD. `3
uperlino ag ' liabilities,judgments, costs and expenses which CONST.TAX'. / A�1
ay in an ay accrue into id City in contact, ce the PERMIT ISSUANCE 10.00 I'1, _ /
ranting uperiruil. MECH.CONT. LIG NO. TOTAL49D)� TOTAL / r7q,
Woe fAppficatrf/CWnfraElor )ate
OFFICE COPY