18071 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 18071 AooREss /,,• .1 80 71
r ` BUILDING - ELECTRICAL-PLUMBING -MECHANICAL fi` lJ
GWNER'$ PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
!S NE P A'I D
NAAIER ITORs UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.bit LIGHTING FIXTURES 10.00/1.00 LIAR' �9 1993
CONTRACTOR'Si �1 C IR10 f1a PPLIANCES-RESIDENTIAL 4.00
A O DRESS �CW
Ste- p� 'I D ZONE PANELS 10.00 CITY bd�E•OVG14tl�A'�IdN ^.
ORRDHIrEcr PANELS (OVER 200 AMP) 20,00 'PLAN CHECK FEE P.C.NO.
ENGINEER �� /
LIC,uo. SIGNS TRANS. 3.00
ARCH OnRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
^��� ZIP EMP.METER OR POLE INS. _ 20.00
�rmul rs4M 5. t,g�1D�n0 $1 MOTORS SEE FEE SCH.
5w IKIAf V
if� 2 SERVICE CHANGE 20.00
o o - LICENSED CONTRACTORS DECLARATIONRNALED
- .=
a u firm w 1 hereby althat I am licensed under provisions of Chapter 9 ISSUANCE DATE
z (commencing with Section 70001 of Division 3 of the Business and
y a H O , ` BLDG. ELECT. PLG. MECH.
F o i' I'rolessM.,Codc,andyn 1' IN,is in full fur ,1py�fffr i ❑ ❑ ❑
0 o"�,' Liccnm- =�-3 Lic.Numbcr, _!Ti7_
m r o Date /'� yfb Contract _
a m BUILDING PERMIT
a OWNERBUILDERDECLARA DATE - / �!
¢ " LSC.- RE ORD INFORMATION
w 1 hereby him that I am exempt from the Contractor's License
VALUATION
' F l� oa Wwfor the following rcawa(Scc.7031.5.Nusinessand l'rofcsions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter,
w ¢ S CONTI h
improve,demolis ,or repair any structure,prior to its issuance,also ELEC. LIC.NO.
E
A. n O LEC.
o u requires the applicant for such permit to I a signed statement that TOTAL PERMIT TO
w$y he is licensed pursuant to the provisions of the Contractors License
F z a o Law(Chapter 9(commencingwith Section 70001 of Division 3 of(he
•�i Business and Professions Cudc)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
I-� the basis for the alleged exemption.Any violin ion of Section 7031.5 - - STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant toacivil Penalty
of not more than Ihundred dollars(55001.1: ALTER-DRAIN&VENT
-WATER (EA.) 5.00
0 1,as owner of the propery,or my employees with wages as BACKFLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work.and the structure is not.
intended or offered for sale (Sec. 7044, Boon. and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 -
Co,,:The Contractor's License Law does not apply to an owner of
property who milds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
-vv ments are not intended or offered for sac.If,however,the building GAS-EA.SYSTEM-I INC:4 OUTLETS 6.00
or improvement is sold within Beoyear of completion,the owner- GAS EA.SYSTEM OVER 4(EA) 200
budder will have the burden of pmving that he did not build on in,- - - . .
- BUILDING USE
prove for purpose of Vele.). RES .,IND CON PB Other
Cl I,as owner of the property,am cx,Ibmvcl INDUSTRIAL WASTE INTER. ^''30.00 ❑ ❑ ❑ ❑ ❑
P 1 Y. Y.7044,Bu with
and
contractors o The
project(Sec. 7044,ot app LAWN SPRINKLERS-1 INC,5 V.B. 6.00 ASSESSORS PARCEL N0.
and Professions Code:The Conbuild% s imloo law does not apply
co an Its for
of h projects
who huilds tt improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
film reels for such License
with a eom4emrf.0 licensed pursuant to
the Cnnt4cmr's License Law. ' SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL No.
N.O I ant cxempl under Sc.-,B.&P.G.ba,this WATER HEATER W/VENT '] 60.19 Q0 -7. 60 - '
son
Owner Date WATER SYSTEM _5.80 ACC.DATE ACD.FILE NO.
WORK ER S'COMPCNSATION DECLARATION WA TER TREATING EQUIP. 5.00
I nerehy all that 1 have a certificate of convent to self-insure, ZONING
or a certificate
5 of 7Wj4orrkkers'Compensation Insurance,or a certified ENG.SITE NO.
t PolicylNou11_ZL-l%6 RPmy.1. 1_: � -fr- tEb1od
Q ❑ Cerifiedfupyisherebyformsh-el. lye, FIRE SPRINK ENERGYT P4
Z 2 pp Certife opy u cJ with l�s�fei_ _ unAdivuibn. MISC.- REFER TO ORD. ❑' ❑ ❑ ❑
ApIIIIC'JIl( �O//f1'7� V N V N
~ O_ PERMIT ISSUANCE
LU CER'111'IC MPE SWIG T10N FROM W KERS' FLOOD ZONE . A.L.U.C.
W � COMPENSATION INSURANCE PLG.CONTR. LIC,NO,
CL Z This action need not be completed if the permit is for one Wa�'G( f'S 7 TOTAL [, v❑ N❑ V❑ N❑
U O hundred dollars(SI00)or II,.)
certify that in the performance of the work for which this per- OTY. MECHANICAL-PERMIT FEE FEE SUMMARY
W U mil is issued,I shall not employ any person in any manner w us.to
econw hsubject to the Workers'Compensation
Q w Laws of Culilomia.
a' Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
>_ En NOTICE TO APPLICANT: If,after making this Centincme of Ex-
� Z emption,you should become subject to the Workers'Compenv4ion APPLIANCE 5.00 PLA c 42 CK
provisions of the Labor Code, you most hothwah comply with - FEE '
U Bach provisions or this Ishall he dean ed revoked AIR HANDLING UNIT(TO 10000.F.M) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00C.F.M.) 6.00 IC E
1 hereby affirm Ih5t there is a Construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 �•�v •( wthl NU
the pcTmournee of the work for which this permit is issued(Sec. MICRV FtIL�JI
3097,civ...). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
NHEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Name ELECTRIC -
I cerifylhat l have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state lows relating to building c nsvunion, and BOILER-GOAT I3 H.ROr1D0,D00B.T.UJ 6.00 1.4
hereby authoriic representatives of this oily In oene inion Inc BOILER-COMPIOver 100,000 BTU)BEE FEE SCH. - MECHANICAL
above-mentioned property for Inspection purpoxs.
(we) agree to Save, indemnify and keep hornless the City of MISC.-. REFER TO ORD.
upenino against liabihtles,judgments, costs and expensest which PERMIT ISSUANCE 10.00 CONST.TAX '
m
ay
wag
agai"sl By in consecimmee of the
isMECH.CONL LIC.NO. TOTALTOTA me or Da
OFFICE COPY