10205 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBERAPPLICATION & PERMIT
aoaowc 10205
PDD E55
kLDING-ELECTRICAL-PLUMBING-MECHANICAL -
PLAN CHECK VALIDATION
NA ELECTRIC PERMIT FEE
PHONE , a3
NDAME CTORS 1 UTLETS-SWITCHES-RECEP 10.00/1.00
�^ L b.� ' LIGHTING FIXTURES 10.00/1.00
AJIV TOes ,nn''r.��` � � '� m( PPLIANCES-RESIDENTIAL 4.00
PANELS 10.00
DATE OF APPLICATION
A HI ECT PANELS (OVER 200 AMP) 2o0.00 PLAN CHECK FEE P.C.NO.
N•.NGINEER
uc.NO SIGNS TRANS. 3.00
ARCH,OR ADDRESS ENG, SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT'S
ADDRESS -' MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
�/�
0
Lee o LICENSED CONT RACTORS DECLARATION TEMP.POLE 30.00 //a'
< u I hereby affirm that 1 um licensed under provisions of Chapter 9 -
Z w6 ISSUANCE DATE
m a In (commencing wilt,Section 7000)of Division 3 of the Business and
F m Z I'rufessic ns Code•and my license is in full felt BLDG. ELECT. PLG. MECH.
p Z m o Lilc Clase�u. sem„__Lin.Contractor == � ❑ ❑ ❑
LI JILT(\`-/�-Contractor
Q y
IS o: w a OWNHR-BUILDER DECLARATION BUILDING PERMIT
A D MISC.- REFER TO ORD INFORMATION
K
g LL N I hereby affirm that 1 am exempt tram the Contractor's License
u0j Law for tile following reason.ISec.7031.5,Business Professions VALUATION
- PERMIT ISSUANCE 10.00
sin� Code:Any city or countypair any structure,
uites a permit priorto tonstruct,,clot
R R ¢ 0 Improve,demolish,ortepav any structure,poor to IIS rssuance,a15o ELEC.CONTE. LIC.NO.
as
0 IS requires the applicant for such permit to file it signed statement that TOTAL
A w ea he is licensed pursuant to the provisions of the Contr:mtor's License PERMIT TO
FZ Law(Chapter 9(eolormwing with Section 7000)of-Division 3 ofthe y�L e2
i o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE PP U
m H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
s ; _ byany applicant for a permit subjects The applicant ma civil penalty
ALTER-DRAIN&VENT-WATER IEA.) 5.00
of not more than five hundred dollars(5500).):
❑ L as owner of the property,or my employees with wages as BACK FLOW PROTECTDEVICE 4.00
their sole compensation,will do the work,and the structure is not . OCC.GROUP RES.UNITS
intended oroffered for rale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property die builds or improves thereon•and who does such work FIXTURES-PERTRAP 5.00 So.FT.FLOOR AREA TOTAL ACREAGE
himself orthrough his own employees,provided that such improve
ments arenot intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improsement is sold within one year of completion, Lite owner-
_0 builder w11 have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
it a forpurpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
/❑ I,Is owner of the property,an,exclusively cmvracling with
' in
rontractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Pro£ssions Code The Contractor's License Law does not apply
to an orner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contra ci lin such projects will,a contractar(sl licensed pursuant to
the Codractor's License Law. SEWER-SANITARY-STORMEA.200ft/10.00 TRACT No. PARCEL No.
❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT
reason) 6.00
Owner' Date WATER SYSTEM 5.00
_ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hreby affirm that I have a certificate of consent toself-insure,
or C of tate of We kers'Co penin' n I su nce r rtific ZONING ENG.SITE NO.
co : L
Po' ,
Of Certified y Isher b m's s
z ❑Certified is feY
fie wi , t �i if n i is 1 FIRE SPR INK ENERGY T-24
Z Apde'anl MISCI REFER TO ORD.
CC O PERMIT ISSUANCE Y ❑ N� Y ❑ N�
LU h ' CIiRTIH C 'MPE EXE PTINS FROM WORKERS' 10.00 FLOODZONE A.LALC.
CL CL d net a cooION INSURANCE PLG.CONTR. LIC.NO. PLG. I
Z this dollars need not he completed if the permit is for one TOTAL Y E] NE] V [] N[J
h,idred dollars(E 100)car less,)
U O ni is ssl ed•that
tsin (fie mol performance of the work for which this per, OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL employ any person in any manner so as to
Ow blare subject to the Workcrs'Compensation Laws of California.
d Iftc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} N I�TICIS 'fO APPLICANT: If,after making this Certificate of Ex-
I- ? minion,you should become subject to the Workeri Co n,pensaticn APPLIANCE 5,00
Investors of the Labor Code, you must forthwith comply with PLAN CHECK
FEE
U ch Provisions or this permit shall be deemed revoked 0 AIR HANDLING UNIT(TO 10 C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
!hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
theperformance of the work for which this permit is issued(Sec.
Soh.CIv.C.). HEATING UNIT(TO 100,000 B.T.U.) 9.00 'MICROFILM
Letter's Name
_ Lider's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
/ I certify that I have read this application and state that the above VENTILATION FAN (SINGLE)• 4.00 imno.tian is correct. I agree to comply with all city and county
dmences and state laws relating to building construction, and BOILER-COW(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
( it.S y authorize representatives of this city to enter upon the s
awe-mentioned property for inspection purposes. BOILER-COMP Wiser 100,000 BTU)SEE FEE SCH. MECHANICAL
--- IWO agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Perrino against liabilities,judgments, costs and expenses which
in any y accrue against said City in nseque ce of the PERMIT ISSUANCE 10.00 CONST.TAX
tin of th� ermit.
MECHA AA .CONT. LIG NO. MECH.
TOTALNA
TOTAL h
arae f t/Contractor Date
OFFICE COPY